Country differences and determinants of yield in programmatic migrant TB screening in four European countries

Abstract

<b>INTRODUCTION</b> The WHO End TB Strategy emphasises early diagnosis and screening of TB in high-risk groups, including migrants. We analysed TB yield data from four large migrant TB screening programmes to inform TB policy.<b>METHODS</b> We pooled routinely collected individual TB screening episode data from Italy, the Netherlands, Sweden and the United Kingdom under the European Union Commission E-DETECT.TB grant, described characteristics of the screened population, and analysed TB case yield.<b>RESULTS</b> We collected data on 2,302,260 screening episodes among 2,107,016 migrants, mostly young adults aged 18-44 years (77.8%) from Asia (78%) and Africa (18%). There were 1,658 TB cases detected through screening, with substantial yield variation (per 100,000): 201.1 for Sweden (95% confidence intervals CI 111.4-362.7<i>)</i>, 68.9 (95% CI 65.4-72.7) for the United Kingdom, 83.2 (95% CI 73.3-94.4) for the Netherlands and 653.6 (95% CI 445.4-958.2) in Italy. Most TB cases were notified among migrants from Asia (<i>n</i> = 1,206, 75/100,000) or Africa (<i>n</i> = 370, 76.4/100,000), and among asylum seekers (<i>n</i> = 174, 131.5/100,000), migrants to the Netherlands (<i>n</i> = 101, 61.9/100,000) and settlement visa migrants to the United Kingdom (<i>n</i> = 590, 120.3/100,000).<b>CONCLUSIONS</b> We found considerable variations in yield across programmes, types of migrants and country of origin. These variations may be partly explained by differences in migration patterns and programmatic characteristics.