Evaluating 17 years of latent tuberculosis infection screening in north-west England: a retrospective cohort study of reactivation

Zenner, Dominik; Loutet, Miranda; Harris, Ross; Wilson, Stephen; Ormerod, L P

doi:10.1183/13993003.02505-2016

Cited by 29 publications

(34 citation statements)

References 17 publications

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“…A study from the UK conducted in recent migrants from high TB incidence areas demonstrated that among migrants with LTBI, those who had LTBI treatment based on a positive IGRA had a significantly reduced risk of TB during the observation period compared with untreated LTBI-positive patients (incidence rate ratio 0.17, 95% CI 0.05-0.60) [38].…”

Section: Screening For Ltbimentioning

confidence: 99%

Screening for tuberculosis in migrants and visitors from high-incidence settings: present and future perspectives

et al. 2018

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In most settings with a low incidence of tuberculosis (TB), foreign-born people make up the majority of TB cases, but the distribution of the TB risk among different migrant populations is often poorly quantified. In addition, screening practices for TB disease and latent TB infection (LTBI) vary widely. Addressing the risk of TB in international migrants is an essential component of TB prevention and care efforts in low-incidence countries, and strategies to systematically screen for, diagnose, treat and prevent TB among this group contribute to national and global TB elimination goals.This review provides an overview and critical assessment of TB screening practices that are focused on migrants and visitors from high to low TB incidence countries, including pre-migration screening and post-migration follow-up of those deemed to be at an increased risk of developing TB. We focus mainly on migrants who enter the destination country application for a long-stay visa, as well as asylum seekers and refugees, but briefly consider issues related to short-term visitors and those with long-duration multiple-entry visas. Issues related to the screening of children and screening for LTBI are also explored.

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Section: Screening For Ltbimentioning

confidence: 99%

Screening for tuberculosis in migrants and visitors from high-incidence settings: present and future perspectives

et al. 2018

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“…In most cases, addressing the underlying factors are perceived as complementary rather than the fulcrum around which efforts to eliminate TB should revolve [ 17 , 18 ]. While improvement in existing tests are necessary and would contribute to minimising TB reactivation among high risk groups [ 19 ], there are debates about the accuracy of the existing screening tests to predict progression from LTBI to active TB [ 19 , 20 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

Towards TB Elimination in Aotearoa/New Zealand: Key Informant Insights on the Determinants of TB among African Migrants

2018

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Migrants living in low incidence countries, including New Zealand (NZ), are disproportionately affected by tuberculosis (TB). This foreign-born group poses important challenges to achieving the national TB elimination targets. Thus, the aim of this study was to contribute to the understandingof factors that influence the incidence of TB among African migrants living in NZ. We employed a semi-structured interview approach to explore the perceptions of NZ-based African community leaders, health professionals and a non-governmental TB support organisation about the wider determinants of TB. The findings, though not completely generalizable, suggest that many NZ-based Africans endure a difficult process of integration, perceive themselves as least susceptible to TB and have low awareness about available health services. Furthermore, the cost of general practitioner (GP) services, mistrust of health professionals, TB stigma and the NZ immigration policy were indicated as important barriers to TB services. Strategies to address TB among migrants must therefore be more holistic and not be centred on a fragmented approach that overemphasises the biomedical approaches, as the incidence of TB is more likely the outcome of a complex interplay of several underlying factors.

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“…25 The epidemiology of TB in England supports the notion that LTBI treatment could be of great benefit for recent immigrants from countries with high TB burden. 2,[26][27][28] In our cohort, none of the participants that were screened for LTBI developed active TB within the observed time period, potentially indicating the benefit of this intervention to reduce the number of incident TB cases. However, our results indicate that the effectiveness of this intervention might be affected by low attendance to primary care, as only half of the eligible new-entrant migrants registered in primary care.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of pre-entry active tuberculosis and post-entry latent tuberculosis screening in new entrants to the UK: a retrospective, population-based cohort study

Berrocal-Almanza

Harris

Lalor

et al. 2019

The Lancet Infectious Diseases

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Background Evaluating interventions that may lead to a reduction in people diagnosed with tuberculosis (TB) in high-income low incidence countries is key to accelerate progress towards elimination. We assessed the effectiveness of pre-entry active TB and post-entry latent TB infection (LTBI) screening to reduce TB incidence and the effect of primary care access on TB incidence in new-entrant migrants to the UK. Methods We performed a population-based cohort study of migrants from 66 countries, who were negative for active TB at pre-entry screening between January 1, 2011 and December 31, 2014 and were eligible for LTBI screening. We used record linkage to track their first contact with primary care, uptake of LTBI screening and development of active TB in England, Wales or Northern Ireland. To assess the effectiveness of the pre-entry screening programme we identified a control group of migrants not screened for active TB using the specific code for new-entrants registering in primary care within the NHS patient registration data system. Our primary outcome was development of active TB notified to the National Enhanced Surveillance System (ETS). in this population. The pre-entry and LTBI screening programmes are likely to be responsible for the reduction in TB incidence in the UK. However, the LTBI programme will only succeed by securing early access to health services, because its effectiveness may be compromised by low attendance to primary care. The pre-entry screening programme provides an opportunity to actively deliver health promotion to inform its participants about the LTBI screening and primary care registration upon UK arrival. Likewise, the compulsory payment of an immigration health surcharge must be coupled with information on entitlements and the importance of primary care registration as entry point to the health system in the UK. Conroy, without their support this study would have not been possible. Authors' contributions: DZ, LCBA, and AL conceptualised the initial hypothesis, conceived and designed the study. LCBA and RH analysed the data. LCBA wrote the first draft of the manuscript. LCBA, AMO and AM performed the record linkage. All authors contributed substantially to data acquisition and interpretation, and revision and editing of the manuscript. Conflict of interest statement: AL is named inventor on patents pertaining to T cell-based diagnosis, including IGRA technologies. Some of these patents were assigned by the University of Oxford to Oxford Immunotec plc resulting in royalty entitlements for the University of Oxford and AL. All other authors declare no competing interests.

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Evaluating 17 years of latent tuberculosis infection screening in north-west England: a retrospective cohort study of reactivation

Cited by 29 publications

References 17 publications

Screening for tuberculosis in migrants and visitors from high-incidence settings: present and future perspectives

Screening for tuberculosis in migrants and visitors from high-incidence settings: present and future perspectives

Towards TB Elimination in Aotearoa/New Zealand: Key Informant Insights on the Determinants of TB among African Migrants

Effectiveness of pre-entry active tuberculosis and post-entry latent tuberculosis screening in new entrants to the UK: a retrospective, population-based cohort study

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