Active case finding for tuberculosis among high-risk groups in low-incidence countries [State of the art series. Case finding/screening. Number 3 in the series]

Zenner, Dominik; Southern, Jo; Hest, Rob van; Vries, Gerard de; Stagg, Helen R.; Antoine, D; Abubakar, Ibrahim

doi:10.5588/ijtld.12.0920

Cited by 61 publications

(30 citation statements)

References 66 publications

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“…This may be explained by differences in migrant groups, migration routes and countries of origin. Other reviews comparing different types of screening (pre-, upon- or post-entry screening) for TB in migrants in low-incidence TB countries report high variations in the yield of screening [37]. This may explain the different conclusions of health economic evaluations regarding the cost-effectiveness of screening for active TB [38].…”

Section: Discussionmentioning

confidence: 99%

Yield of active screening for tuberculosis among asylum seekers in Germany: a systematic review and meta-analysis

et al. 2017

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All asylum seekers in Germany undergo upon-entry screening for tuberculosis TB, but comprehensive evidence on the yield is lacking. We compared the national estimates with the international literature in a systematic review and meta-analysis of studies reporting the yield of TB, defined as the fraction of active TB cases detected among asylum seekers screened in Germany upon entry. We searched 11 national and international databases for empirical studies and the internet for grey literature published in English or German without restrictions on publication time. Among 1,253 screened articles, we identified six articles reporting the yield of active TB based on German data, ranging from 0.72 (95% confidence interval (CI): 0.45–1.10) to 6.41 (95% CI: 4.19–9.37) per 1,000 asylum seekers. The pooled estimate across all studies was 3.47 (95% CI: 1.78–5.73; I2 = 94.9%; p < 0.0001) per 1,000 asylum seekers. This estimate was in line with international evidence (I2 = 0%; p for heterogeneity 0.55). The meta-analysis of available international estimates resulted in a pooled yield of 3.04 (95% CI: 2.24–3.96) per 1,000. This study provides an estimate across several German federal states for the yield of TB screening in asylum seekers. Further research is needed to develop more targeted screening programmes.

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Section: Discussionmentioning

confidence: 99%

Yield of active screening for tuberculosis among asylum seekers in Germany: a systematic review and meta-analysis

et al. 2017

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“…An ongoing study to evaluate and optimize tuberculosis control in the Netherlands includes an assessment of the cost–effectiveness of each of the control programme’s components 22 , 23 . Other related investigations have tended to focus on the cost–effectiveness of one specific screening component and/or the detection methods used 24 – 27 . One review indicated that screening of migrants as they entered a low-incidence country was not very cost-effective and had little impact on overall tuberculosis trends 25 .…”

Section: Discussionmentioning

confidence: 99%

Cost–effectiveness of screening for active cases of tuberculosis in Flanders, Belgium

Smit

Apers

Oñate

et al. 2016

Bull. World Health Organ.

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ObjectiveTo assess the cost–effectiveness of the tuberculosis screening activities currently funded by the Flemish government in Flanders, Belgium.MethodsAfter estimating the expenses for 2013–2014 of each of nine screening components – which include high-risk groups, contacts and people who are seeking tuberculosis consultation at a centre for respiratory health care – and the associated costs per active case of tuberculosis identified between 2007 and 2014, we compared the cost–effectiveness of each component. The applied perspective was that of the Flemish government.FindingsThe three most cost-effective activities appeared to be the follow-up of asylum seekers who were found to have abnormal X-rays in initial screening at the Immigration Office, systematic screening in prisons and contact investigation. The mean costs of these activities were 5564 (95% uncertainty interval, UI: 3791–8160), 11 603 (95% UI: 9010–14 909) and 13 941 (95% UI: 10 723–18 201) euros (€) per detected active case, respectively. The periodic or supplementary initial screening of asylum seekers and the screening of new immigrants from high-incidence countries – which had corresponding costs of €51 813 (95% UI: 34 855–76 847), €126 236 (95% UI: 41 984–347 822) and €418 359 (95% UI: 74 975–1 686 588) – appeared much less cost-effective. Between 2007 and 2014, no active tuberculosis cases were detected during screening in the juvenile detention centres.ConclusionIn Flanders, tuberculosis screening in juvenile detention centres and among new immigrants and the periodic or supplementary initial screening of asylum seekers appear to be relatively expensive ways of detecting people with active tuberculosis.

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“…No information was available on screening at entry ports for these countries [17]. Zenner et al in a 2013 primary cost effectiveness study identified comparable yields among each screening strategy with at entry screening still not found to be cost-effective and having little impact on overall TB trends [18]. In 2009 and 2014 in the USA, Liu et al and Posey et al, evaluating pre-entry (overseas) screening, identified yields substantially higher than in the UK new entrants screening [19, 20].…”

Section: Discussionmentioning

confidence: 99%

Outcomes analysis of new entrant screening for active tuberculosis in Heathrow and Gatwick airports, United Kingdom 2009/2010

Severi

Maguire

Ihekweazu³

et al. 2016

BMC Infect Dis

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BackgroundIn 2012, the United Kingdom (UK) Government announced that the new entrant screening for active tuberculosis (TB) in Heathrow and Gatwick airports would end. Our study objective was to estimate screening yield and diagnostic accuracy, and identify those at risk of active TB after entry.MethodsWe designed a retrospective cohort study and linked new entrants screened from June 2009 to September 2010 through probabilistic matching with UK Enhanced TB Surveillance (ETS) data (June 2009 to December 2010). Yield was the proportion of cases reported to ETS within three months of airport screening in the screened population. To estimate screening diagnostic accuracy we assessed sensitivity, specificity, positive and negative predictive values. Through Poisson regression we identified groups at increased risk of TB diagnosis after entry.ResultsWe identified 200,199 screened entrants, of these 59 had suspected TB at screening and were reported within 3 months to ETS (yield = 0.03 %). Sensitivity was 26 %; specificity was 99.7 %; positive predictive value was 13.2 %; negative predictive value was 99.9 %. Overall, 350 entrants were reported in ETS. Persons from countries with annual TB incidence higher than 150 cases per 100,000 population and refugees and asylum seekers were at increased risk of TB diagnosis after entry (population attributable risk 77 and 3 % respectively).ConclusionAirport screening has very low screening yields, sensitivity and positive predictive value. New entrants coming from countries with annual TB incidence higher than 150 per 100,000 population, refugees and asylum seekers should be prioritised at pre- or post-entry screening.

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Active case finding for tuberculosis among high-risk groups in low-incidence countries [State of the art series. Case finding/screening. Number 3 in the series]

Cited by 61 publications

References 66 publications

Yield of active screening for tuberculosis among asylum seekers in Germany: a systematic review and meta-analysis

Yield of active screening for tuberculosis among asylum seekers in Germany: a systematic review and meta-analysis

Cost–effectiveness of screening for active cases of tuberculosis in Flanders, Belgium

Outcomes analysis of new entrant screening for active tuberculosis in Heathrow and Gatwick airports, United Kingdom 2009/2010

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