European Respiratory Journal
Volume 37, Issue 5, 2011, Pages 1175-1182

Tuberculosis screening of migrants to low-burden nations: Insights from evaluation of UK practice (Article) (Open Access)

Pareek M. , Abubakar I. , White P.J. , Garnette G.P. , Lalvani A.*
  • a Tuberculosis Research Unit, Dept. of Respiratory Medicine, National Heart and Lung Institute, London, United Kingdom, Dept. of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
  • b Tuberculosis Section, Centre for Infections, Health Protection Agency, London, United Kingdom, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, United Kingdom
  • c MRC Centre for Outbreak Analysis and Modelling, London, United Kingdom, Modelling and Economics Unit, Centre for Infections, Health Protection Agency, London, United Kingdom
  • d MRC Centre for Outbreak Analysis and Modelling, London, United Kingdom
  • e Tuberculosis Research Unit, Dept. of Respiratory Medicine, National Heart and Lung Institute, London, United Kingdom

Abstract

Tuberculosis (TB) primarily occurs in the foreign-born in European countries, such as the UK, where increasing notifications and the high proportion of foreign-born cases has refocused attention on immigrant (new entrant) screening. We investigated how UK primary care organisations (PCOs) screen new entrants and whether this differs according to TB burden in the PCOs (incidence <20 or ≥20 cases per 100,000 per annum). An anonymous, 20-point questionnaire was sent to all 192 UK PCOs asking which new entrants are screened, who is screened for active TB/latent TB infection (LTBI) and the methods used. Descriptive analyses were undertaken. Categorical responses were compared using the Chi-squared test. 177 (92.2%) out of 192 PCOs responded; all undertook screening action in response to abnormal chest radiographs, but only 107 (60.4%) screened new entrants for LTBI. Few new entrants had active TB diagnosed (median 0.0%, interquartile range (IQR) 0.0-0.5%) but more were identified with LTBI (median 7.85%, IQR 4.30-13.50%). High-burden PCOs were significantly less likely to screen new entrants for LTBI (OR 0.26, 95% CI 0.12-0.54; p<0.0001). Among PCOs screening for LTBI, there was substantial deviation from national guidance in selection of new entrant subgroups and screening method. Considerable heterogeneity and deviation from national guidance exist throughout the UK new entrant screening process, with high-burden regions undertaking the least screening. Forming an accurate picture of current front-line practice will help to inform future development of European new entrant screening policy. Copyright©ERS 2011.

Author Keywords

Screening Migration tuberculosis Latent tuberculosis

Index Keywords

descriptive research immigrant primary medical care mass screening human diagnostic accuracy controlled study priority journal screening test Great Britain Young Adult Humans Adolescent Lung Emigrants and Immigrants latent tuberculosis tuberculosis questionnaire diagnostic test Incidence Article Questionnaires tuberculin test adult major clinical study United Kingdom thorax radiography primary health care
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-79955674413&doi=10.1183%2f09031936.00105810&partnerID=40&md5=6d95a0de50850f0daf52a2cfb5657356
DOI: 10.1183/09031936.00105810
ISSN: 09031936
Cited by: 38
Original Language: English