Delivering multi-disease screening to migrants for latent TB and blood-borne viruses in an emergency department setting: A feasibility study

Abstract

Background Screening for latent tuberculosis infection (LTBI) in migrants is important for elimination of tuberculosis in low-incidence countries, alongside the need to detect blood-borne infections to align with new guidelines on migrant screening for multiple infections in European countries. However, feasibility needs to be better understood. Methods We did a feasibility study to test an innovative screening model offering combined testing for LTBI (QuantiFERON), HIV, hepatitis B/C in a UK emergency department, with two year follow-up. Results 96 economic migrants, asylum seekers and refugees from 43 countries were screened (46 [47.9%] women; mean age 35.2 years [SD 11.7; range 18–73]; mean time in the UK 4.8 years [SD 3.2; range 0–10]). 14 migrants (14.6%) tested positive for LTBI alongside HIV [1], hepatitis B [2], and hepatitis C [1] Of migrants with LTBI, 5 (35.7%) were successfully engaged in treatment. 74 (77.1%) migrants reported no previous screening since migrating to the UK. Conclusion Multi-disease screening in this setting is feasible and merits being further tested in larger-scale studies. However, greater emphasis must be placed on ensuring successful treatment outcomes. We identified major gaps in current screening provision; most migrants had been offered no prior screening despite several years since migration, which holds relevance to policy and practice in the UK and other European countries.

Prevention, testing, and treatment interventions for hepatitis B and C in refugee populations: results of a scoping review

“…Additionally, tracking the status of vaccination, testing, and treatment may be difficult among these transitory populations. One study mentioned that screening interventions are only effective when supported by appropriate follow-up and linkage to care [ 31 ], while another study debated the usefulness of HBV and HCV screening, given the expensive treatment and long-term management that it requires in a highly mobile population [ 32 ]. Potential methods to explore in supporting continuity of care are retaining refugees’ health and contact information in the healthcare system and building easier pathways for refugees to enter a healthcare system.…”

Improving the detection of infectious diseases in at-risk migrants with an innovative integrated multi-infection screening digital decision support tool (IS-MiHealth) in primary care: A pilot cluster-randomized controlled trial

“…All of this, alongside to the fact of including infections that have evidence-based report a clear benefit to be screened for, 17 , 18 and the fact of being a multi-disease approach may reduce the cost impact on health system. 40 Although there exist other screening tools for migrant, they usually target other topics such as mental health and they are not integrated in the EPR. 41 …”

Health inequalities in the management of chronic hepatitis B virus infection in patients from sub-Saharan Africa in high-income countries

“…Opportunistic programmes have shown success at identifying patients with chronic HBV and linking them to care in single UK centres. 80 This also provides an opportunity to encourage vaccination among family members of identified patients and to prevent new infections among sexually active adolescents and adults. Screening of migrants arriving from countries with either poor diagnostic capabilities or HBV prevalence >1% appears cost-effective and should be undertaken as part of migration assessment.…”