Tuberculosis case finding based on symptom screening among immigrants, refugees and asylum seekers in Rome

Abstract

BackgroundIn Italy the proportion of cases of tuberculosis in persons originating from high-prevalence countries has been increasing in the last decade. We designed a study to assess adherence to and yield of a tuberculosis screening programme based on symptom screening conducted at primary care centres for regular and irregular immigrants and refugees/asylum seekers.MethodsPresence of symptoms suggestive of active tuberculosis was investigated by verbal screening in migrants presenting for any medical condition to 3 free primary care centres in the province of Rome. Individuals reporting at least one symptom were referred to a tuberculosis clinic for diagnostic workup.ResultsAmong 2142 migrants enrolled, 254 (11.9%) reported at least one symptom suggestive of active tuberculosis and 176 were referred to the tuberculosis clinic. Of them, 80 (45.4%) did not present for diagnostic evaluation. Tuberculosis was diagnosed in 7 individuals representing 0.33% of those screened and 7.3% of those evaluated for tuberculosis.ConclusionThe overall yield of this intervention was in the range reported for other tuberculosis screening programmes for migrants, although we recorded an unsatisfactory adherence to diagnostic workup. Possible advantages of this intervention include low cost and reduced burden of medical procedures for the screened population. Further evaluation of this approach appears to be warranted.

Lessons learnt from TB screening in closed immigration centres in Italy

“…This coverage compares well with the 63.9% coverage reported by another TB symptom screening programme conducted in Italian primary care centres for migrants. 13 A systematic review of TB screening programs for persons migrating to European countries found a high variability in screening coverage ranging from below 20 to almost 100%, with higher figures on asylum seekers and in compulsory screening programmes. 20 …”

“…Clinical variables included: history of TB, history of previous TB contact, cough for more than 3 weeks, fever for at least 7 days, night sweats in the last 3 months, weight loss >10% in the last 3 months, one episode of haemoptysis in the last 3 months, and chest pain. 13 Persons with a positive TB questionnaire (i.e., those having at least one positive answer to the eight clinical questions) were referred to the nearest NHS outpatient clinic for further evaluation. Outcomes of migrants with a positive questionnaire were classified as: active TB, active TB ruled out, not referred to NHS outpatient TB clinic by medical decision, or lost to follow-up (not evaluated at the TB clinic due to individual refusal, discharge/removal from the immigration centres or missing data regarding referral status).…”

“…The project was conducted in four CIEs in Italy and used an active symptom screening approach for active TB case finding, which was already evaluated at primary care centres for migrants in Italy. 13 Here we describe the feasibility and the yield of this programme.…”

The Occurrence of Diseases and Related Factors in a Center for Asylum Seekers in Italy

“…This was reached evaluating the prevalence of disease among asylum seekers in a Sicilian CARA and assessing which factors were associated with more frequent detected diseases. In addition, this manuscript focused on a topic in a setting which the scientific literature on noncommunicable diseases is lacking ( 8 ).…”

Active Tuberculosis Case Finding Interventions among Immigrants, Refugees and Asylum Seekers in Italy

“…10 During years 2009 and 2010 we performed a TB case finding program based on verbal symptom screening conducted at primary centers for regular and irregular immigrants and refugees/asylum seekers at three different sites in Rome. 11 During subsequent years we then tailored this intervention to other settings (temporary settlements reached by mobile-units) and implemented a similar program in two primary health care centers in Rome and Milan.…”