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      Tuberculosis screening in the European migrant population: a scoping review of current practices

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          Abstract

          Responding to a surge in new tuberculosis (TB) cases among migrants from high-incidence countries, low-incidence European nations have heeded World Health Organization recommendations by implementing TB screening in this population. This review aims to synthesise evidence on current screening strategies for active TB and latent tuberculosis infection (LTBI) in European high-income countries, and their main barriers and interventions. PubMed, Web of Science and Scopus were searched from March to April 2023, including articles in English, published in the last decade, pertaining to screening strategies for active TB or LTBI in Europe focused on migrants, excluding those exclusively composed of refugees, asylum seekers or other migrant populations. 32 studies fit the criteria. Screening in migrants varies between countries regarding timing, population, screening location and diagnosis. Furthermore, some barriers prevent migrants from benefiting from screening, namely physical, cultural and professional barriers. Additional research is needed to determine the patterns through which regular migrants adhere to current screening strategies in European countries.

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          Several important barriers hinder the effective TB screening of migrants. Additional research is needed to comprehend the patterns through which regular migrants adhere to existing TB screening strategies in European countries. https://bit.ly/3Pi6A4l

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          PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation

          Adrian Aldcroft, Chantelle Garritty, Simon Lewin … (2018)
          Scoping reviews, a type of knowledge synthesis, follow a systematic approach to map evidence on a topic and identify main concepts, theories, sources, and knowledge gaps. Although more scoping reviews are being done, their methodological and reporting quality need improvement. This document presents the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist and explanation. The checklist was developed by a 24-member expert panel and 2 research leads following published guidance from the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network. The final checklist contains 20 essential reporting items and 2 optional items. The authors provide a rationale and an example of good reporting for each item. The intent of the PRISMA-ScR is to help readers (including researchers, publishers, commissioners, policymakers, health care providers, guideline developers, and patients or consumers) develop a greater understanding of relevant terminology, core concepts, and key items to report for scoping reviews.
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            Scoping studies: towards a methodological framework

            Lisa O'Malley, Hilary Arksey (2005)
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              Prognostic value of interferon-γ release assays and tuberculin skin test in predicting the development of active tuberculosis (UK PREDICT TB): a prospective cohort study

              Ibrahim Abubakar, Francis Drobniewski, Jo Southern … (2018)
              Summary Background Tackling tuberculosis requires testing and treatment of latent tuberculosis in high-risk groups. The aim of this study was to estimate the predictive values of the tuberculin skin test (TST) and two interferon-γ release assays (IGRAs) for the development of active tuberculosis in high-risk groups—ie, people in recent contact with active tuberculosis cases and from high-burden countries. Method In this prospective cohort study, we recruited participants from 54 centres (eg, clinics, community settings) in London, Birmingham, and Leicester in the UK. Participants were eligible if they were aged 16 years or older and at high risk for latent tuberculosis infection (ie, recent contact with someone with active tuberculosis [contacts] or a migrant who had arrived in the UK in the past 5 years from—or who frequently travelled to—a country with a high burden of tuberculosis [migrants]). Exclusion criteria included prevalent cases of tuberculosis, and participants who were treated for latent tuberculosis after a positive test result in this study. Each participant received three tests (QuantiFERON-TB Gold-In Tube, T-SPOT.TB, and a Mantoux TST). A positive TST result was reported using three thresholds: 5 mm (TST-5), 10 mm (TST-10), and greater than 5 mm in BCG-naive or 15 mm in BCG-vaccinated (TST-15) participants. Participants were followed up from recruitment to development of tuberculosis or censoring. Incident tuberculosis cases were identified by national tuberculosis databases, telephone interview, and review of medical notes. Our primary objective was to estimate the prognostic value of IGRAs compared with TST, assessed by the ratio of incidence rate ratios and predictive values for tuberculosis development. The study was registered with ClinicalTrials.gov, NCT01162265, and is now complete. Findings Between May 4, 2010, and June 1, 2015, 10 045 people were recruited, of whom 9610 were eligible for inclusion. Of this cohort, 4861 (50·6%) were contacts and 4749 (49·4%) were migrants. Participants were followed up for a median of 2·9 years (range 21 days to 5·9 years). 97 (1·0%) of 9610 participants developed active tuberculosis (77 [1·2%] of 6380 with results for all three tests). In all tests, annual incidence of tuberculosis was very low in those who tested negatively (ranging from 1·2 per 1000 person-years, 95% CI 0·6–2·0 for TST-5 to 1·9 per 1000 person-years, 95% CI 1·3–2·7, for QuantiFERON-TB Gold In-Tube). Annual incidence in participants who tested positively were highest for T-SPOT.TB (13·2 per 1000 person-years, 95% CI 9·9–17·4), TST-15 (11·1 per 1000 person-years, 8·3–14·6), and QuantiFERON-TB Gold In-Tube (10·1 per 1000 person-years, 7·4–13·4). Positive results for these tests were significantly better predictors of progression than TST-10 and TST-5 (eg, ratio of test positivity rates in those progressing to tuberculosis compared with those not progressing T-SPOT.TB vs TST-5: 1·99, 95% CI 1·68–2·34; p<0·0001). However, TST-5 identified a higher proportion of participants who progressed to active tuberculosis (64 [83%] of 77 tested) than all other tests and TST thresholds (≤75%). Interpretation IGRA-based or BCG-stratified TST strategies appear most suited to screening for potential disease progression among high-risk groups. Further work will be needed to assess country-specific cost-effectiveness of each screening test, and in the absence of highly specific diagnostic tests, cheap non-toxic treatments need to be developed that could be given to larger groups of people at potential risk. Funding National Institute for Health Research Health Technology Assessment Programme 08-68-01.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Breathe (Sheff)
                Journal ID (iso-abbrev): Breathe (Sheff)
                Journal ID (publisher-id): BREATHE
                Journal ID (hwp): breathe
                Title: Breathe
                Publisher: European Respiratory Society
                ISSN (Print): 1810-6838
                ISSN (Electronic): 2073-4735
                Publication date (Print): March 2024
                Publication date (Electronic): 14 May 2024
                Volume: 20
                Issue: 1
                Electronic Location Identifier: 230357
                Affiliations
                [1 ]Hospital Sousa Martins - Unidade Local de Saúde da Guarda, Guarda, Portugal
                [2 ]EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
                [3 ]Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
                [4 ]Estudo das Populações, ICBAS – Instituto de Ciencias Biomédicas Abel Salazar da Universidade do Porto, Porto, Portugal
                [5 ]Unidade de Investigação Clínica da Administração Regional de Saúde do Norte, Porto, Portugal
                [6 ]Serviço de Pneumologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
                Author notes
                Corresponding author: Sara Braga ( sara_bmachado@ 123456hotmail.com )
                Author information
                https://orcid.org/0000-0003-1066-767X
                https://orcid.org/0000-0002-2406-3159
                https://orcid.org/0000-0002-0117-0701
                https://orcid.org/0000-0003-1450-6670
                https://orcid.org/0000-0003-2257-3099
                Article
                Publisher ID: EDU-0357-2023
                DOI: 10.1183/20734735.0357-2023
                PMC ID: 11091716
                PubMed ID: 38746905
                SO-VID: a70b1dca-754d-4efa-804b-3748eff384c4
                Copyright © Copyright ©ERS 2024
                License:

                Breathe articles are open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions@ 123456ersnet.org

                History
                Date received : 02 January 2024
                Date accepted : 04 March 2024
                Categories
                Subject: Reviews
                Subject: 4

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