Tackling TB in migrants arriving at Europe’s southern border

Abstract

Over a quarter of the individuals diagnosed with tuberculosis [TB] in the European Union region are born outside of the area and the proportion has been increasing steadily. Italy is a low TB incidence country with over 50% of TB cases in the foreign-born population primarily due to the high numbers of migrants entering the country via land or sea. As a case study to evaluate the value of screening in newly arrived migrants, the EDETECT-TB project in Italy implemented and evaluated active TB screening in the migrant population at first reception centres to ensure early diagnosis to avoid further spread. Based on a cost-effectiveness analysis from a program provider perspective, a decision tree model allowed the assessment of the value for money of case finding by estimating the cost per case of active TB detected compared with the status quo of no screening. The analysis confirmed that early case detection is a cost-effective intervention in areas with migrants arriving from high TB risk settings. Targeted post-arrival early screening of high TB risk vulnerable new entrants to Italy has a potential role in reducing the spread of TB among migrants.

Cost-effectiveness of active tuberculosis screening among high-risk populations in low tuberculosis incidence countries: a systematic review, 2008 to 2023

“…Four studies from the United Kingdom (UK) involved foreign-born immigrants, contacts of PTB index cases, people with substance use disorder, people experiencing homelessness, people with lower incomes and PLHIV as a target population [ 15 - 18 ]. Additionally, studies from Italy and Germany involved migrants, while the Belgian study focused on migrants as well as on asylum seekers, people in prison, contacts and other people who did not belong to any specific group [ 21 - 23 ]. Eight of the nine studies demonstrated that screening was cost-effective compared with no screening, the passive screening method or other alternatives [ 15 - 18 , 20 - 23 ].…”

“…Additionally, studies from Italy and Germany involved migrants, while the Belgian study focused on migrants as well as on asylum seekers, people in prison, contacts and other people who did not belong to any specific group [ 21 - 23 ]. Eight of the nine studies demonstrated that screening was cost-effective compared with no screening, the passive screening method or other alternatives [ 15 - 18 , 20 - 23 ].…”

“…Screening of migrants in first reception centres at Italian borders costed EUR 40,702.33 and a cost of a true positive case detected was EUR 2,712.97, lower than the median cost for detection of active PTB cases using the passive system in Italian hospitals (EUR 8,280.01) [ 23 ].…”

“…All the nine articles included were on active PTB cases in low-incidence countries in high-risk cohorts, such as people in prison, migrants, asylum seekers, youths in juvenile detention centres, nursing homes, people with substance use disorder, contacts of TB cases and isolated communities [15][16][17][18][19][20][21][22][23]. A summary of the articles reviewed is in Table 1.…”

World Tuberculosis Day 2021 Theme — ‘The Clock is Ticking’ — and the world is running out of time to deliver the United Nations General Assembly commitments to End TB due to the COVID-19 pandemic

“…Over 50% of TB cases in Italy are foreign born migrants. Goscé et al (2021) describe the EDETECT-TB project in Italy which implemented and evaluated active TB screening in the migrant population and their study confirmed that early case detection is a cost-effective intervention and that targeted post-arrival early screening ensures that potential further transmission is averted.…”