Aldridge, RW;
Zenner, D;
White, PJ;
Abubakar, I;
Hayward, AC;
(2014)
Pre-entry screening programmes for tuberculosis in migrants to low-incidence countries: a systematic review and meta-analysis.
The Lancet Infectious Diseases
, 14
(12)
pp. 1240-1249.
10.1016/S1473-3099(14)70966-1.
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Abstract
Background: Several high income countries have pre-entry screening programmes for tuberculosis. We aimed to establish the yield of pre-entry screening programmes in order to inform evidence based policy for migrant health screening. Methods: Six bibliographic databases were searched for experimental or observational studies, and systematic reviews, reporting data on migrant screening for active and latent tuberculosis by any method occurring prior to migration to a low-incidence country. Primary outcomes were principal reported screening yield of active tuberculosis; yield of culture confirmed cases; and yield of sputum smear for acid-fast bacilli cases. Where appropriate, fixed effects models were used to summarise the yield of pre-entry screening across included studies. Findings: A total of 15 unique studies with data on 3,739,266 migrants screened pre-entry for tuberculosis between 1982 and 2010 were identified. Heterogeneity was high for all primary outcomes. After stratifying by prevalence in country of origin heterogeneity was reduced for culture and smear confirmed cases. Culture confirmed yield increased with prevalence in the country of origin, and summary estimates ranged from 20 (95%CIs: 10, 32) to 336 per 100,000 individuals screened (95%CIs: 283, 393) in countries with a prevalence of 50-149 and greater than 350 per 100,000 population respectively. Interpretation: Targeting high-prevalence countries is likely to result in the highest yield for active disease. Pre-entry screening should be considered as part of a broader package of measures to ensure early diagnosis and effective management of migrants with active tuberculosis, and be integrated with initiatives addressing the health needs of migrants.
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