Case Study:

NHS Wales Drug-Resistant TB Toolkit

Quickly delivering digital interventions in response to emerging obstacles


High rates of Tuberculosis (TB), including drug-resistant TB, in Ukraine exceed those in the UK. The humanitarian crisis in Ukraine led to refugees arriving in the UK, raising public health concerns due to the absence of routine TB vaccination.

An emergency response was necessary to promptly screen Ukrainian refugees for TB. Asylum seekers and refugees face high risks of TB reactivation, emphasising the importance of early screening to detect active TB and prevent ongoing transmission.

Following the successful implementation of the COVID hospital guideline using ICST’s Emergency Implementation Science Methodology, ICST was tasked with developing and implementing a solution.


Drug-Resistant TB Toolkit

ICST was tasked with producing and implementing two innovations:

1 - TB Team Guideline

A guideline for designated TB teams within each health board, outlining protocols for the identification, screening, assessment, and management of refugees.

2 - National Data Collection Effort

Establishing a national data collection effort in Wales to record the screening of all refugees at risk of drug-resistant TB upon arrival. This data aims to facilitate coordinated healthcare provision and policy development.

ICST recognised that the effectiveness of the innovations depended largely on their implementation. As part of the implementation methodology, ICST emphasised the active alignment of key stakeholders to overcome barriers to implementation. To ensure widespread adoption, ICST also supported NHS Wales in running awareness campaigns before the launch of the toolkit. These campaigns included various outreach efforts such as events, emails, notifications, and more.

Learn More About:

Drug-Resistant TB Toolkit

A strategy to improve the standards of respiratory care across a health system, ensuring that all patients receive high-value care, and all healthcare professionals understand how to optimise the care for their patients.


Drug-Resistant TB Toolkit

Publications and editorials

The success of the toolkit was published in Thorax in January 2024 and was featured as part of the editorial of that edition, being praised for its implementation and delivery.

Quick development and implementation

Rapidly implemented guidelines were crucial as refugees from Ukraine arrived in the UK, necessitating a quick process for identification, publication, and implementation to protect families and refugees from active TB infection.

TB cases identified and treated

The toolkit successfully identified and treated cases of TB through the screening program, effectively preventing ongoing transmission.

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