Abstract
BackgroundScreening for latent tuberculosis infection (LTBI) in migrants is important for elimination of tuberculosis in low-incidence countries, alongside the need to detect blood-borne infections to align with new guidelines on migrant screening for multiple infections in European countries. However, feasibility needs to be better understood. MethodsWe did a feasibility study to test an innovative screening model offering combined testing for LTBI (QuantiFERON), HIV, hepatitis B/C in a UK emergency department, with two year follow-up. Results96 economic migrants, asylum seekers and refugees from 43 countries were screened (46 [47.9%] women; mean age 35.2 years [SD 11.7; range 18–73]; mean time in the UK 4.8 years [SD 3.2; range 0–10]). 14 migrants (14.6%) tested positive for LTBI alongside HIV [1], hepatitis B [2], and hepatitis C [1] Of migrants with LTBI, 5 (35.7%) were successfully engaged in treatment. 74 (77.1%) migrants reported no previous screening since migrating to the UK. ConclusionMulti-disease screening in this setting is feasible and merits being further tested in larger-scale studies. However, greater emphasis must be placed on ensuring successful treatment outcomes. We identified major gaps in current screening provision; most migrants had been offered no prior screening despite several years since migration, which holds relevance to policy and practice in the UK and other European countries.
Highlights
Migrants in Europe face a disproportionate burden of TB, as well as other priority infectious diseases such as HIV, and hepatitis B and C, compared to host populations, comprising over 70% of cases in some low-incidence countries [1,2,3,4,5,6,7,8]
Migrant screening programmes in European countries to date have predominantly focused on single diseases – mainly active TB – [10], yet data suggest that combining screening for multiple key infections at one appointment in migrant groups could be effective, with increased acceptability, uptake, and better treatment outcomes in more integrated approaches [11,12,13,14,15]
Published guidelines from the European Centre for Disease Prevention and Control (ECDC) [16] has called for consideration to be given to screening and vaccination for multiple infections in newly arrived migrants to the European Union (EU)/European Economic Area (EEA) on arrival, with a focus on latent TB infection (LTBI), active TB, hepatitis B and C, HIV, vaccine-preventable diseases, and parasitic infections; the extent to which the recommendations made can be implemented in practice in migrantreceiving EU/EEA countries is as yet unclear
Summary
Migrants (defined as foreign born) in Europe face a disproportionate burden of TB, as well as other priority infectious diseases such as HIV, and hepatitis B and C, compared to host populations, comprising over 70% of cases in some low-incidence countries [1,2,3,4,5,6,7,8]. Renewed focus has recently been given to delivering targeted LTBI screening and treatment in high-risk groups – including migrant populations – as an effective and cost-effective approach to averting cases of active TB [2,19,20,21], aligning with WHO's END TB strategy targets [22,23] and Travel Medicine and Infectious Disease 36 (2020) 101611 new ECDC guidelines(16). Most current guidelines recommend testing for LTBI in new migrants from high-incidence countries (⩾150 per 100,000), with screening and treatment being implemented across Europe in migrant and other high-risk populations [24]. Screening for latent tuberculosis infection (LTBI) in migrants is important for elimination of tuberculosis in low-incidence countries, alongside the need to detect blood-borne infections to align with new guidelines on migrant screening for multiple infections in European countries. We identified major gaps in current screening provision; most migrants had been offered no prior screening despite several years since migration, which holds relevance to policy and practice in the UK and other European countries
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