Abstract
An increasing number of countries with low incidence of tuberculosis have pre-entry screening programmes for migrants. We present the first estimates of the prevalence of and risk factors for tuberculosis in migrants from 15 high-incidence countries screened before entry to the UK. We did a population-based cross-sectional study of applicants for long-term visas who were screened for tuberculosis before entry to the UK in a pilot programme between Oct 1, 2005, and Dec 31, 2013. The primary outcome was prevalence of bacteriologically confirmed tuberculosis. We used Poisson regression to estimate crude prevalence and created a multivariable logistic regression model to identify risk factors for the primary outcome. 476 455 visa applicants were screened, and the crude prevalence of bacteriologically confirmed tuberculosis was 92 (95% CI 84-101) per 100 000 individuals. After adjustment for age and sex, factors that were strongly associated with an increased risk of bacteriologically confirmed disease at pre-entry screening were self-report of close or household contact with an individual with tuberculosis (odds ratio 11·6, 95% CI 7·0-19·3; p<0·0001) and being an applicant for settlement and dependant visas (1·3, 1·0-1·6; p=0·0203). Migrants reporting contact with an individual with tuberculosis had the highest risk of tuberculosis at pre-entry screening. To tackle this disease burden in migrants, a comprehensive and collaborative approach is needed between countries with pre-entry screening programmes, health services in the countries of origin and migration, national tuberculosis control programmes, and international public health bodies. Wellcome Trust, Medical Research Council, and UK National Institute for Health Research.
Highlights
Medical screening of migrants for tuberculosis has been implemented for more than a century, but only recently have data been systematically obtained and analysed to understand its effectiveness.[1,2,3] Screening can occur before entry, at entry, or after entry
To improve international pre-entry screening programmes, we investigated the prevalence of and risk factors for tuberculosis in migrants from high-incidence countries screened before migration, using historical data from the 15 countries in the UK pilot programme
Study design We did a population-based cross-sectional study of migrants applying for visas to stay in the UK for more than 6 months, who were screened for tuberculosis before entry in 15 countries taking part in a pilot programme
Summary
Medical screening of migrants for tuberculosis has been implemented for more than a century, but only recently have data been systematically obtained and analysed to understand its effectiveness.[1,2,3] Screening can occur before entry (ie, pre-entry screening), at entry (sometimes called port-of-entry screening), or after entry. The UK screened migrants before, at, and after entry.[5] In May, 2012, the UK Government announced the transition to a fully pre-entry system, expanding the screening programme from 15 pilot locations in operation from 2005, to 101 high-incidence countries (ie, those with a WHO-estimated prevalence of >40 cases per 100 000 population). This transition occurred in four phases and was completed on March 31, 2014 (appendix p 9). To improve international pre-entry screening programmes, we investigated the prevalence of and risk factors for tuberculosis in migrants from high-incidence countries screened before migration, using historical data from the 15 countries in the UK pilot programme
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