Tuberculosis (TB) is the world’s biggest killer among infectious diseases — and yet it’s curable. While global efforts continue to eliminate TB, the UK’s low incidence rate brings its own set of challenges: delayed diagnoses, persistent stigma, and low public awareness. This episode of Connecting Citizens to Science explores how these factors shape TB care and prevention in the UK, and what it will take to ensure no one is left behind in the global push to end TB.

In this episode:

Kate Bradfield - Community TB Nursing Team Leader, North Merseyside, University Hospitals of Liverpool Group

Kate has been a TB specialist nurse since 2020 and now leads the North Merseyside service, driving quality improvement and community-based support for patients. Her work focuses on ensuring people can complete treatment successfully while managing both clinical and social challenges.

Amina Farah - Programme Manager, Latent Tuberculosis Infection Screening Programme, Liverpool

Amina has worked in TB since 2016 and brings both professional insight and personal experience, having supported a family member through TB treatment. She leads efforts to identify and treat latent TB infections in at-risk groups, addressing stigma and promoting early diagnosis and awareness.

Useful links:

• LSTM Centre for Tuberculosis Research
• Tuberculosis Community Team :: NHS University Hospitals of Liverpool Group
• The Union World Conference on Lung Health 2025

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The podcast cuts across disciplines, including health systems strengthening, gender and intersectionality, tropical diseases (NTDs, TB, Malaria), maternal and child healthcare (antenatal and postnatal care), mental health and wellbeing, vector-borne diseases, climate change and co-production approaches.

If you would like your project or programme to feature in an episode or miniseries, get in touch with the producers of Connecting Citizens to Science, the SCL Agency.

Speaker: 00:00:04

Dr. Kim Ozano: Hello, and welcome back to Connecting Citizens to Science.

Speaker: 00:00:07

I'm your host, Dr. Kim Ozano, and this is a podcast where we explore global

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health and development by bringing together researchers, practitioners,

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and community voices to share insights that can help drive positive change.

Speaker: 00:00:19

Before we round off our gender justice series, we're gonna take

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a moment to focus on tuberculosis.

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This is a topic that's at the front of people's minds this month with the

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Union World Conference on Lung Health.

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In this episode, we're going to be looking at what TB really

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looks like in the UK today.

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It's a disease that many assume has disappeared, but which continues to

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affect thousands of people each year.

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To help us explore this in more detail, we're joined by Kate Bradfield,

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who is a community TB nursing team leader for North Merseyside at the

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University Hospitals of Liverpool Group.

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Kate has been a TB specialist nurse since 2020, and she now leads the

Speaker: 00:00:58

service driving quality improvement and community-based support for patients.

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We are also joined by Amina Farrah, who is a programme manager for

Speaker: 00:01:06

the Latent Tuberculosis Infection Screening Programme in Liverpool.

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Amina has worked in TB since 2016 and brings both professional insight and

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personal experience as someone whose own family has been affected by the disease.

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And today, they share what's happening on the ground, how stigma continues

Speaker: 00:01:24

to shape people's experiences and what it takes to support patients

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through long and often challenging but successful treatment journeys.

Speaker: 00:01:32

Let's get into it.

Speaker: 00:01:37

We've talked about TB on this podcast before in lots of different contexts,

Speaker: 00:01:42

but today we're gonna talk about TB and the UK, and a lot of people in the UK

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think that it doesn't really exist in the UK or it's not really a problem and

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we want to know more about the reality.

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So, we have some fantastic guests with us today to talk to us about that.

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So, Kate, welcome to the podcast.

Speaker: 00:02:00

It's great to have you here with us.

Speaker: 00:02:02

Perhaps you could start by describing the TB situation in the UK and globally.

Kate: 00:02:07

In the UK since I've been a TB nurse, what we found is our

Kate: 00:02:11

rates in North Mersey have doubled in terms of active TB. And I think

Kate: 00:02:17

that does echo the national picture.

Kate: 00:02:20

And there's lots of reasons for that, one of them being delayed

Kate: 00:02:22

diagnosis following COVID.

Kate: 00:02:24

But I think what's quite good for us is we do have access to

Kate: 00:02:28

healthcare, and we do have free treatment for TB. And we do have the

Kate: 00:02:33

infrastructure required to deliver that.

Kate: 00:02:34

Although our rates have doubled, they are very low.

Kate: 00:02:37

We are still maintaining that very low instance recognised rate by

Kate: 00:02:42

the World Health Organisation.

Kate: 00:02:43

Globally it is still the number one killer in infectious diseases.

Kate: 00:02:48

So, we still see an estimated number of cases of 10.8 million people being

Kate: 00:02:54

infected with TB, and we still see people dying globally, and there

Kate: 00:02:58

isn't really a reason for it.

Kate: 00:03:00

It should be ended.

Kate: 00:03:01

It shouldn't continue to affect people, but it is, it all comes

Kate: 00:03:05

down to finances, doesn't it?

Kate: 00:03:07

And that's supporting the infrastructure that's required

Kate: 00:03:09

in resource poor-countries.

Kate: 00:03:11

Dr. Kim Ozano: Thank you very much.

Kate: 00:03:12

So, 10.8 million globally.

Kate: 00:03:14

Do you have those numbers for here in the UK?

Kate: 00:03:17

We are seeing a rise.

Kate: 00:03:18

In 2023 the notifications were 4,831, and then within a year that went up to 5,490.

Kate: 00:03:29

So it doesn't, you think, oh no, it's only another sort of 600.

Kate: 00:03:33

But it's a lot.

Kate: 00:03:34

And that's a, it's a 13% increase, which is significant.

Kate: 00:03:39

So, not nowhere near the same numbers that you've got in countries

Kate: 00:03:44

where they don't have the same infrastructure and free healthcare.

Kate: 00:03:48

In the UK, we have infectious diseases teams, we've got specialist nurses like

Kate: 00:03:53

myself and Amina that look after people in their own home and we make sure

Kate: 00:03:57

that they can get through treatment and manage the sometimes very debilitating

Kate: 00:04:01

side effects of the TB medication and support them with the social costs,

Kate: 00:04:06

like not being able to work, and trying to navigate systems of welfare.

Kate: 00:04:12

Dr. Kim Ozano: I think when the numbers are lower, often, cases can

Kate: 00:04:15

get misdiagnosed or the awareness is probably not the same as some of

Kate: 00:04:19

the other diseases here in the UK.

Kate: 00:04:21

Amina, as well as having 10 years experience as a TB nurse, you also

Kate: 00:04:25

have personal experience of this, and what it means to have a diagnosis.

Kate: 00:04:30

Could you talk to us a bit about that?

Amina: 00:04:33

Yeah.

Amina: 00:04:34

Sure.

Amina: 00:04:34

A close family member of mine was diagnosed with TB.

Amina: 00:04:37

It was my elderly mother.

Amina: 00:04:40

At the time she would've been about 74.

Amina: 00:04:43

I didn't work in TB, then I worked in cardiology.

Amina: 00:04:46

Before she was diagnosed with TB we were back and forth to the GP numerous

Amina: 00:04:52

times because she had history of a long-standing cough night sweats, fever,

Amina: 00:04:59

a cough that just wasn't shifting really.

Amina: 00:05:02

And how it happened was she was going to the dentist initially to get her teeth

Amina: 00:05:06

removed for her dentures to be fitted, and obviously she couldn't really eat because

Amina: 00:05:12

her teeth were being removed, and during that time she just became really tired and

Amina: 00:05:17

developed this cough, couldn't really eat.

Amina: 00:05:20

So, we took her to the GP.

Amina: 00:05:21

They prescribed her antibiotics which helped a little bit at

Amina: 00:05:24

first, but nothing really shifted.

Amina: 00:05:27

During that time, her symptoms became worse.

Amina: 00:05:31

Her cough, it was the night sweats that were quite alarming really.

Amina: 00:05:35

When we say night sweats, it was just drenching night sweats of a nighttime.

Amina: 00:05:39

So, we just go back to the GP and again, different types of antibiotics.

Amina: 00:05:44

Nothing was helping.

Amina: 00:05:46

Symptoms again became worse.

Amina: 00:05:48

The cough, lethargic, the night sweats.

Amina: 00:05:51

But then she became a little bit confused.

Amina: 00:05:53

So, she had a chest x-ray eventually, but we didn't get the results for the

Amina: 00:05:57

x-ray because we had to take her into the hospital due to confusion, and

Amina: 00:06:01

we're thinking what's going on here?

Amina: 00:06:03

I think the GP was looking for a cancer diagnosis, really.

Amina: 00:06:07

So they said 'It's not cancer.

Amina: 00:06:09

I don't really know what it is.' But we're gonna look into it, but

Amina: 00:06:12

in the meantime, she did get worse and we took her to the hospital.

Amina: 00:06:16

She was then diagnosed with Milary TB, disseminated TB, so

Amina: 00:06:21

TB kinds of everywhere, really in her body and her brain as well.

Amina: 00:06:24

And that's why she became a little bit confused towards the end.

Amina: 00:06:28

So, she was given treatment.

Amina: 00:06:30

She stayed on treatment for about a year.

Amina: 00:06:32

During that time as she was getting a little bit better, the nurses did come and

Amina: 00:06:36

visit, and that's the reason why I ended up into TB because we didn't really know

Amina: 00:06:40

about TB as a family, what it was , the signs and symptoms really to look out for.

Amina: 00:06:45

So, the nurses were amazing that used to come and see her.

Amina: 00:06:47

It used to help her in terms of her mood and minimise that stigma because,

Amina: 00:06:53

Mum was old school, and she was quite stoic, and she didn't really want

Amina: 00:06:56

anybody to know that it a TB diagnosis.

Amina: 00:06:59

And she was like, 'Oh no, it's that infectious disease and can you tell

Amina: 00:07:02

people that it's pneumonia and it's not TB? She was in hospital for a month I

Amina: 00:07:06

think, and then started to get better and came home, but the take home for

Amina: 00:07:11

me was the kind of the late diagnosis.

Amina: 00:07:14

The nurses were amazing, giving us education, not being scared,

Amina: 00:07:18

relieving my Mum of these anxieties.

Amina: 00:07:21

'Cause she quite healthy at the time and she was really poorly.

Amina: 00:07:23

And now, being in TB and understanding she might have being exposed to TB and had

Amina: 00:07:29

latent TB for a long time, and then, as she's gone to the dentist to get a tooth

Amina: 00:07:34

out when she's not eating, and immune system's maybe dropped a little bit.

Amina: 00:07:38

It's maybe the bacteria might have woken up into active disease.

Amina: 00:07:42

So yeah, so that's why I became a TB nurse and came into TB.

Kate: 00:07:46

I think that's one of the major things.

Kate: 00:07:48

We still have a delayed diagnosis for people because they aren't referred

Kate: 00:07:53

on to the right services early on, because GPs will rarely come across TB,

Kate: 00:08:00

unless you live in a city where there has been a lot of cases, it's not on

Kate: 00:08:05

your list of differential diagnoses

Kate: 00:08:09

We still are a low instance country, a very low incidence country, we

Kate: 00:08:13

still see a lot of delayed diagnosis.

Kate: 00:08:15

And that's because of the delays in primary care, and there isn't a network

Kate: 00:08:20

of awareness raising at the moment.

Kate: 00:08:22

Dr. Kim Ozano: And as the NHS becomes more pressurised , I can

Kate: 00:08:25

see this will become a harder job.

Kate: 00:08:27

So Amina, you raised so many things in your story, you talked

Kate: 00:08:31

a little bit about stigma.

Kate: 00:08:33

Maybe you could talk to us a little bit about stigma, but also

Kate: 00:08:37

any gender differences around TB?

Amina: 00:08:39

Yeah, there, there is still quite a bit of stigma really, but

Amina: 00:08:43

again it's having that lack of education really and understanding

Amina: 00:08:47

that there is treatment out there and to seek that treatment and take it.

Amina: 00:08:52

It's a long duration really to be on treatment for six months or a year.

Amina: 00:08:56

Yeah.

Amina: 00:08:56

It's hard for people taking tablets every day.

Amina: 00:08:59

But, that's our job really, and that's our role to support people through that

Amina: 00:09:03

and minimise that stigma and and get people through treatment successfully.

Kate: 00:09:07

The World Health Organisation Global Report reported in

Kate: 00:09:10

2024, 55% of men are affected.

Kate: 00:09:13

What I do find interesting is locally 66% of our patients are males.

Kate: 00:09:19

So, we can see that gender difference is still there no matter

Kate: 00:09:23

what your healthcare system is.

Kate: 00:09:25

It can be much more difficult to screen men for TB than women.

Kate: 00:09:28

So, it's trying to adapt to that really, and I don't think our healthcare

Kate: 00:09:32

system doesn't necessarily meet that person where they're at because our

Kate: 00:09:36

service is a nine to five service.

Kate: 00:09:38

We can't, we can't put our blood tests in after four o'clock.

Kate: 00:09:44

Yeah.

Kate: 00:09:44

So, trying to get somebody who is on a zero hours contract and has a family and

Kate: 00:09:49

children to feed and their wife can't work 'cause she's got tuberculosis.

Kate: 00:09:54

That's, that can be quite challenging.

Kate: 00:09:56

Dr. Kim Ozano: And in terms of women, is there anything to

Kate: 00:09:59

raise around women's experience?

Kate: 00:10:00

What we have to be careful about with women in

Kate: 00:10:02

particular is pregnant women.

Kate: 00:10:04

Pregnant women and children...

Amina: 00:10:05

Small children...

Kate: 00:10:06

Yeah.

Kate: 00:10:06

Are very vulnerable when it comes to TB and can have quite poor outcomes.

Kate: 00:10:11

Dr. Kim Ozano: Could you tell us a bit more about contact tracing

Kate: 00:10:13

and case finding in the UK?

Kate: 00:10:15

Is that something that's active?

Amina: 00:10:17

If you've got somebody that's been diagnosed with TB and they're

Amina: 00:10:21

worried about, obviously the stigma they don't really wanna tell people that

Amina: 00:10:26

they've got TB, so they don't really come forward with names of any close

Amina: 00:10:32

contacts within the family household.

Amina: 00:10:34

So, we do have to build a really good relationship with our patients

Amina: 00:10:38

to relieve that anxiety and stress.

Kate: 00:10:40

We do contact tracing of active cases and then also we're

Kate: 00:10:45

quite lucky here, aren't we?

Kate: 00:10:47

Because we're funded to do screening for latent TB.

Amina: 00:10:53

It's called the latent TB programme in Liverpool.

Amina: 00:10:56

And there is a criteria, and the criteria is you have to be between

Amina: 00:11:00

the ages of 16 to 35 and come from a very high instance TB country.

Amina: 00:11:05

The majority of people will say, 'I haven't got TB'.

Amina: 00:11:08

And I said what we're looking for is the exposure and then, if they have a

Amina: 00:11:12

positive blood test, to offer screen treatment, then of antibiotics and

Amina: 00:11:17

just to minimise the risk of them developing active TB later on in life.

Amina: 00:11:21

It's quite successful.

Amina: 00:11:22

Dr. Kim Ozano: Yeah, well done.

Amina: 00:11:23

So, I get in a real picture here in the UK, there's a lot of awareness

Amina: 00:11:28

raising that needs to happen.

Amina: 00:11:29

What really strikes me is this is such a person-centered approach because it has

Amina: 00:11:34

to be, you have to know the patients, you have to know the families, you have to

Amina: 00:11:38

work with them and really navigate any fear or stigma that they might experience,

Amina: 00:11:43

which takes very specific skills.

Amina: 00:11:45

So I can imagine being a TB nurse you definitely have to

Amina: 00:11:48

have that specific skillset.

Amina: 00:11:51

Is there any other barriers in your role that you face?

Kate: 00:11:54

If you have to wear a mask, that's a pain because you wanna

Kate: 00:11:58

smile at someone and you wanna make them feel like you care about them.

Kate: 00:12:03

And if you're using an interpreter, that can be quite challenging because

Kate: 00:12:06

you're trying to convey that, that you do care and you do want to

Kate: 00:12:10

listen to them and understand their situation and meet them where they are.

Kate: 00:12:14

Amina and I have both worked with patients that have got drug sensitive TB, and we've

Kate: 00:12:18

also worked with patients that have got multidrug resistance, and it is truly

Kate: 00:12:24

challenging to take tablets every day for a year, and they have to take lots of

Kate: 00:12:28

tablets when they're multidrug resistant.

Kate: 00:12:30

And actually, sometimes you just literally have to hold their hand.

Kate: 00:12:36

There's nothing medics can do 'cause they have to take this treatment.

Kate: 00:12:39

We try our best to limit these side effects, but actually what's really

Kate: 00:12:44

important is just sitting with them.

Kate: 00:12:46

Dr. Kim Ozano: There's a lot of new findings and I think learning

Kate: 00:12:50

from other countries globally as well that's coming into practice.

Kate: 00:12:53

How has that affected you over the 10 years as you've seen that progress?

Kate: 00:12:57

I've been working for the team for five years, Amina for 10.

Kate: 00:13:02

And in that time, there's always work going on in the background, isn't there?

Kate: 00:13:06

But on the front line, what you're seeing isn't very much, do you know what I mean?

Kate: 00:13:12

The thing that has happened though, that is a real game changer for our whole

Kate: 00:13:16

patients who have multidrug-resistant TB. So that's where we have standard drugs

Kate: 00:13:22

that we use and work really well, but there are drug resistant strains of TB.

Kate: 00:13:28

So, in that case, the regiments have been really complex for, for all that time.

Kate: 00:13:34

18 months to two years of treatment, very gruelling side effects for the patients.

Kate: 00:13:39

But what we have seen is these advances in the six-month regimes,

Kate: 00:13:44

we've got two patients on the six-month regiments and the difference

Kate: 00:13:49

that's gonna make to their lives.

Kate: 00:13:50

They'll get through this period of their lives so much quicker.

Kate: 00:13:55

It's so challenging to sit with someone and say, yeah, you will get

Kate: 00:13:58

through this, and you will be cured, but it's not gonna be until 2026.

Kate: 00:14:03

You know what I mean?

Kate: 00:14:04

It's all 27 or whatever.

Kate: 00:14:06

So that's been fantastic.

Kate: 00:14:08

Dr. Kim Ozano: Do you learn from other countries globally?

Kate: 00:14:11

Are there lessons that come from the countries that maybe have higher rates

Kate: 00:14:15

that you're able to apply and practice?

Amina: 00:14:18

We look into a lot of research, and we attend conferences around the

Amina: 00:14:23

UK where people do public speaking on the work that they've done abroad

Amina: 00:14:27

and then maybe put in our practice.

Amina: 00:14:30

Fundamentally, I think it the message is the same really, that TB is curable.

Amina: 00:14:35

Dr. Kim Ozano: So, it's come to that time where we wrap up the

Amina: 00:14:37

episode, and we'd like our listeners to go away with some key messages.

Amina: 00:14:42

What do you really want to get out there in terms of a TB and your experience?

Amina: 00:14:48

I think for me, a persistent cough always seek help.

Amina: 00:14:53

A persistent cough lasting more than three to four weeks, coughing up

Amina: 00:14:57

blood, unintentional weight loss, severe, unintentional weight loss,

Amina: 00:15:01

and severe drenching, night sweats.

Amina: 00:15:03

So, I think if these signs and symptoms are not shifting, just to keep persevering

Amina: 00:15:10

a little bit and be a bit more persistent.

Amina: 00:15:11

Dr. Kim Ozano: Thanks very much.

Amina: 00:15:12

And Kate, what do you want our listeners to take home?

Kate: 00:15:16

I think for me anybody can get TB you know, I mean Tom Jones and

Kate: 00:15:20

Tina Turner, they can get TB . Anybody can get TB and I think, Amina is

Kate: 00:15:26

right, people understanding what the symptoms are because often they

Kate: 00:15:29

look like some another illness.

Kate: 00:15:32

But it's thinking about your risk factors.

Kate: 00:15:35

What are your risk factors for TB? Have you travelled to a country

Kate: 00:15:39

with a high burden of TB cases?

Kate: 00:15:43

Unfortunately, drug users and alcoholics are at a higher risk, of TB. People

Kate: 00:15:48

who have malnutrition living in poverty often are disproportionately affected.

Kate: 00:15:54

And I think it's trying to reach those vulnerable groups who may be

Kate: 00:15:59

disproportionately affected to say just keep knocking on the door of your

Kate: 00:16:02

GP and say what if it could be TB?

Kate: 00:16:06

So, I think it's helping people understand it's not a massive problem in the UK,

Kate: 00:16:13

but it is here and the only way to limit cases is for that early diagnosis,

Kate: 00:16:19

which will prevent future complications.

Kate: 00:16:23

Dr. Kim Ozano: So, I think the message is very clear.

Kate: 00:16:25

Anyone can get TB. Keep an eye on those symptoms.

Kate: 00:16:29

If you might be in a vulnerable group or you're a GP or a professional or

Kate: 00:16:33

a researcher, keep an eye out for people who might be vulnerable to this.

Kate: 00:16:37

And a real message to knock on the GPS door, mention it, talk about it.

Kate: 00:16:42

There's nothing to be lost by saying, have you tested for TB? So, thank you very much

Kate: 00:16:46

for talking us through the episode today and talking us through TB and what it

Kate: 00:16:51

looks like in the UK and globally as well.

Kate: 00:16:54

Thanks to our guest today for a really enlightening episode on TB in the UK.

Kate: 00:17:00

What's really interesting is how the issues that we've heard today have kind

Kate: 00:17:04

of overlapped with the issues we've been hearing about in the gender justice

Kate: 00:17:08

miniseries, Backlash, Resistance, and the Path to Gender Justice.

Kate: 00:17:12

From stigma and inequality to access and power; they're all part of the

Kate: 00:17:16

same global picture, and we are seeing the same kind of things emerging.

Kate: 00:17:20

We will be continuing with the Gender Justice podcast with the final

Kate: 00:17:24

episode, which we will launch before the Christmas break, and then in the

Kate: 00:17:28

New Year we'll be bringing you more stories and insights from across the

Kate: 00:17:31

global health and development context.

Kate: 00:17:34

So, if you're working in this space and have a story, experience,

Kate: 00:17:37

or idea you'd like to share, we really would love to hear from you.

Kate: 00:17:41

You can reach out to The Connecting Citizens to Science production team

Kate: 00:17:44

at the Stop, Collaborate and Listen Agency, and of course, make sure you

Kate: 00:17:49

subscribe wherever you get your podcasts so you don't miss what's coming next,

Kate: 00:17:53

and you can find links to the Union World Conference on Lung Health and

Kate: 00:17:56

related TB resources in the show notes.

Kate: 00:17:59

So, check those out, and until next time, stay connected.