Abstract
Several high-income countries have pre-entry screening programmes for tuberculosis. We aimed to establish the yield of pre-entry screening programmes to inform evidence-based policy for migrant health screening. We searched six bibliographic databases for experimental or observational studies and systematic reviews, which reported data on migrant screening for active or latent tuberculosis by any method before migration to a low-incidence country. Primary outcomes were principal reported screening yield of active tuberculosis, yield of culture-confirmed cases, and yield of sputum smear for acid-fast bacilli cases. Where appropriate, fixed-effects models were used to summarise the yield of pre-entry screening across included studies. We identified 15 unique studies with data for 3 739 266 migrants screened pre-entry for tuberculosis between 1982 and 2010. Heterogeneity was high for all primary outcomes. After stratification by prevalence in country of origin, heterogeneity was reduced for culture-confirmed and smear-confirmed cases. Yield of culture-confirmed cases increased with prevalence in the country of origin, and summary estimates ranged from 19·7 (95% CI 10·3-31·5) cases identified per 100 000 individuals screened in countries with a prevalence of 50-149 cases per 100 000 population to 335·9 (283·0-393·2) per 100 000 in countries with a prevalence of greater than 350 per 100 000 population. Targeting high-prevalence countries could result in the highest yield for active disease. Pre-entry screening should be considered as part of a broad package of measures to ensure early diagnosis and effective management of migrants with active tuberculosis, and be integrated with initiatives that address the health needs of migrants. Wellcome Trust, UK National Institute for Health Research, Medical Research Council, Public Health England.
Highlights
Several high-income countries (Australia, Austria, Canada, France, Israel, Jordan, New Zealand, and USA) have pre-entry screening programmes for tuberculosis.[1]
In Europe there has been an absolute decrease in the number of tuberculosis cases reported, but only five countries report a decrease in migrant populations, ten report no change, and 11 report an increase.[3,4]
Outcomes We considered three primary outcomes: the principal yield of pre-entry screening for active tuberculosis reported for each study, yield of active tuberculosis cases confirmed by culture, and yield of active tuberculosis cases confirmed by smear for
Summary
Several high-income countries (Australia, Austria, Canada, France, Israel, Jordan, New Zealand, and USA) have pre-entry screening programmes for tuberculosis.[1] The UK has used a combination of upon-entry and post-entry screening for several decades, but fully transitioned to pre-entry screening on April 1, 2014.2 Migration patterns have led to recent changes in the epidemiological profile of cases in low-incidence settings. The number of people residing outside their country of birth is substantial. A substantial number of migrants move from countries with a high incidence of tuberculosis to those with a low incidence. Several high-income countries have pre-entry screening programmes for tuberculosis. We aimed to establish the yield of pre-entry screening programmes to inform evidence-based policy for migrant health screening
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