Aldridge, RW; (2015) Examining the epidemiology of tuberculosis in migrants to the UK to inform evidence-based screening policies. Doctoral thesis , UCL (University College London).

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Abstract

Background: In high-income countries an increasing proportion of all tuberculosis cases are detected in migrants. Understanding the epidemiology of tuberculosis in migrants to inform evidence-based screening policies is a priority. Methods: A systematic review and meta-analysis of pre-entry screening for tuberculosis was undertaken (chapter 2). Data from a pilot pre-entry programme in migrants to the UK was described, and risk factors for prevalent cases examined (chapter 3). The accuracy of a novel method for identifying individuals between two datasets was studied (chapter 4). This linkage method was used to combine data from migrants screened pre-entry to the UK tuberculosis register including molecular strain typing data. The linked datasets enabled estimates of the incidence of tuberculosis to be calculated, and risk factors were identified (chapters 5 and 6). Results: The systematic review identified 15 studies and found that culture confirmation increased with WHO prevalence in the country of origin. The crude prevalence of bacteriologically confirmed tuberculosis identified by UK pre-entry screening was 92 per 100,000 population screened. Migrants reporting a history of contact with a case of tuberculosis, and those from higher prevalence countries were at greatest risk. Compared to a gold standard of NHS number, probabilistic linkage identified individuals in two datasets with high sensitivity and specificity. The estimated incidence of tuberculosis notified in the UK in migrants screened pre-entry was 194 per 100,000 person years at risk. Migrants with a chest radiograph classified as suspected tuberculosis and those from higher prevalence countries had a higher risk post- migration. Compared to other non-UK born individuals, migrants screened pre-entry were less likely to be the first case in a cluster of tuberculosis. Conclusions: This thesis generated new knowledge that improves our understanding of the epidemiology of tuberculosis in migrants to the UK. Based on these findings, evidence-based screening recommendations were made.

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