Country differences and determinants of yield in programmatic migrant TB screening in four European countries

Abstract

Introduction

The WHO End-TB Strategy emphasises early diagnosis and screening of tuberculosis (TB) in high-risk groups, including migrants. We analysed TB yield data from four large migrant TB screening programmes to inform TB policy.

Methods

We pooled routinely collected individual TB screening episode data from Italy, the Netherlands, Sweden, and the UK under the EU Commission E-DETECT.TB grant, described characteristics of the screened population, and analysed TB case yield.

Results

We collected data on 2,302,260 screening episodes among 2,107,016 migrants, mostly among young adults (aged 18-44, 77.8%) from Asia (78%) and Africa (18%). There were 1,658 TB cases detected through screening with substantial yield variation (per 100,000), being 201.1 for Sweden (111.4-362.7), 68.9 (65.4-72.7) for the UK, 83.2 (73.3-94.4) for the Netherlands and 653.6 (445.4-958.2) in Italy. Most TB cases were notified among migrants from Asia (n=1,206, 75/100,000) or Africa (n=370, 76.4/100,000) and among asylum seekers (n=174, 131.5 per 100,000), migrants to the Netherlands (n=101, 61.9/100,000) and settlement visa migrants to the UK (n=590, 120.3/100,000).

Conclusions

We found considerable variation in yield across programmes, types of migrants and country of origin. This variation may be partly explained by differences in migration patterns and programmatic characteristics.