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Drivers determining TB disease screening yield in four European screening programmes: a comparative analysis

Zenner, Dominik; Brals, Daniella; Nederby-Öhd, Joanna; Menezes, Dee; Aldridge, Robert; Anderson, Sarah; de Vries, Gerard; ... Abubakar, Ibrahim; + view all (2023) Drivers determining TB disease screening yield in four European screening programmes: a comparative analysis. European Respiratory Journal , 61 (5) , Article 2202396. 10.1183/13993003.02396-2022. Green open access

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Abstract

INTRODUCTION: The WHO End-TB Strategy emphasises screening for early diagnosis of tuberculosis (TB) in high-risk groups, including migrants. We analysed key drivers of TB yield differences in four large migrant TB screening programmes to inform TB control planning and feasibility of a European approach. METHODS: We pooled individual TB screening episode data from Italy, the Netherlands, Sweden, and the UK and analysed predictors and interactions for TB case yield using multivariable logistic regression models. RESULTS: Between 2005-2018 in 2,302,260 screening episodes among 2,107,016 migrants to four countries; the programmes identified 1,658 TB cases (yield 72.0 per 100,000; 95% confidence interval, CI68.6-75.6). In logistic regression analysis, we found associations between TB screening yield and age (>55 years odds ratio, OR2.91, CI2.24-3.78), being an asylum seeker (OR3.19, CI1.03-9.83) or on a settlement visa (OR1.78, CI1.57-2.01), close TB contact (OR12.25, 11.73-12.79), and higher TB incidence in the country of origin (CoO). We demonstrated interactions between migrant typology and age, as well as CoO. For asylum seekers, the elevated TB risk remained similar above CoO incidence thresholds of 100 per 100,000. CONCLUSIONS: Key determinants of TB yield included close contact, increasing age, incidence in CoO and specific migrant groups including asylum seekers and refugees. For most migrants such as UK students and workers, TB yield significantly increased with levels of incidence in CoO. The high, CoO-independent TB risk in asylum seekers above a 100 per 100,000 threshold could reflect higher transmission and reactivation risk of migration routes; with implications for selecting populations for TB screening.

Type: Article
Title: Drivers determining TB disease screening yield in four European screening programmes: a comparative analysis
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1183/13993003.02396-2022
Publisher version: https://doi.org/10.1183/13993003.02396-2022
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Tuberculosis, European surveillance, screening programmes, migrants
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics
URI: https://discovery.ucl.ac.uk/id/eprint/10170981
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