Abstract
BackgroundAsylum seekers in Sweden are offered tuberculosis (TB) screening at a voluntary post-arrival health examination. The role of this screening in improving the TB diagnostic pathway has not been previously evaluated. The aim of this study was to determine diagnostic pathways for active TB cases and compare diagnostic delays between different pathways.MethodsRetrospective review of medical records of patients reported with active TB in Stockholm in 2015, using a structured and pre-coded form.ResultsSeventy-one percent of patients actively sought health care due to symptoms. As for source of referral to TB specialist clinic, 15% came from screening of eligible migrants, of whom the majority were asymptomatic. Among asylum seekers, 69% were identified through screening at a health examination (HE). The main sources of referral to TB clinics were emergency departments (27%) and primary health care centers (20%). Median health care provider delay was significantly longer in patients identified through migrant screening in health examination.ConclusionsScreening at a health examination was the main pathway of active TB detection among mainly asymptomatic and non-contagious asylum seekers but contributed modestly to total overall TB case detection. In these patients TB was diagnosed early in a non-contagious phase of the disease. Further research is required to assess the effectiveness and cost-effectiveness of HE TB screening as well as inclusion of other groups of migrants from high incidence countries in the screening program in terms of impact on delay, transmission and treatment outcomes.
Highlights
Asylum seekers in Sweden are offered tuberculosis (TB) screening at a voluntary post-arrival health examination
Few studies have assessed if systematic TB screening can shorten the pathway to diagnosis, compared to the conventional diagnostic pathways starting with symptoms that leads to patients actively seeking care [4, 5]
This study aimed to: i) determine first health care contact and diagnostic pathway distribution for active TB cases, ii) determine the contribution of TB screening in health examination (HE) to overall case detection, iii) compare diagnostic delays by source of referral to TB specialist clinic, and iv) compare health care provider delay in patients detected through TB screening at HE and patients detected through non-screening pathways
Summary
Asylum seekers in Sweden are offered tuberculosis (TB) screening at a voluntary post-arrival health examination The role of this screening in improving the TB diagnostic pathway has not been previously evaluated. Systematic screening for active TB can potentially increase case notification and reduce diagnostic delays the evidence is conflicting. Wikell et al BMC Public Health (2019) 19:151 should be considered as target groups for systematic screening for both active TB and latent TB infection (LTBI) [6,7,8] These guidelines are part of the WHO ‘End TB strategy’ and its adaptation to low-incidence countries, which includes targets of a 90% TB incidence reduction and a 95% reduction in TB deaths by 2035 [1, 9]. The weak evidence might explain the very heterogeneous migrant TB screening policies across European countries with similar TB epidemiology [10]
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