Screening for latent TB, HIV, and hepatitis B/C in new migrants in a high prevalence area of London, UK: a cross-sectional study

BMC Infectious Diseases

Jon S Friedland¹  Joseph Eliahoo¹  Samia Hasan²  Rod Escombe²  Josip Car²  Farah Seedat¹  Sally Hargreaves¹ 

[1] Imperial College London, Department of Medicine, Section of Infectious Diseases and Immunity, Hammersmith Hospital Campus, 8th Floor Commonwealth Building, DuCane Road, London W12 ONN, UK;Hammersmith and Fulham Centres for Health, Hammersmith Hospital, Hammersmith, London

关键词: Health service delivery;    Immigrants;    Latent tuberculosis;    Screening;    HIV;    Tuberculosis;    Hepatitis;    Migrants;   

Others  :  1118249
DOI  :  10.1186/s12879-014-0657-2

 received in 2014-07-04, accepted in 2014-11-24,  发布年份 2014

【 摘 要 】

Background

Rising rates of infectious diseases in international migrants has reignited the debate around screening. There have been calls to strengthen primary-care-based programmes, focusing on latent TB. We did a cross-sectional study of new migrants to test an innovative one-stop blood test approach to detect multiple infections at one appointment (HIV, latent tuberculosis, and hepatitis B/C) on registration with a General Practitioner (GP) in primary care.

Methods

The study was done across two GP practices attached to hospital Accident and Emergency Departments (A&E) in a high migrant area of London for 6 months. Inclusion criteria were foreign-born individuals from a high TB prevalence country (>40 cases per 100,000) who have lived in the UK ≤ 10 years, and were over 18 years of age. All new migrants who attended a New Patient Health Check were screened for eligibility and offered the blood test. We followed routine care pathways for follow-up.

Results

There were 1235 new registrations in 6 months. 453 attended their New Patient Health Check, of which 47 (10.4%) were identified as new migrants (age 32.11 years [range 18–72]; 22 different nationalities; time in UK 2.28 years [0–10]). 36 (76.6%) participated in the study. The intervention only increased the prevalence of diagnosed latent TB (18.18% [95% CI 6.98-35.46]; 181.8 cases per 1000). Ultimately 0 (0%) of 6 patients with latent TB went on to complete treatment (3 did not attend referral). No cases of HIV or hepatitis B/C were found. Foreign-born patients were under-represented at these practices in relation to 2011 Census data (Chi-square test −0.111 [95% CI −0.125 to −0.097]; p < 0.001).

Conclusion

The one-stop approach was feasible in this context and acceptability was high. However, the number of presenting migrants was surprisingly low, reflecting the barriers to care that this group face on arrival, and none ultimately received treatment. The ongoing UK debate around immigration checks and charging in primary care for new migrants can only have negative implications for the promotion of screening in this group. Until GP registration is more actively promoted in new migrants, a better place to test this one-stop approach could be in A&E departments where migrants may present in larger numbers.

【 授权许可】

   
2014 Hargreaves et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Rechel B, Mladovsky P, Ingleby D, Mackenbach JP, McKee M: Migration and health in an increasingly diverse Europe. Lancet 2013, 381(9873):1235-1245.
• [2]Hargreaves S, Friedland JS: Impact On and Use of Health Services by New Migrants in Europe. In Migration, Health and Inequality. Edited by Thomas F, Gideon J. Zed Books, London; 2013.
• [3]Migrant Health: Infectious Diseases in Non-UK Born Populations in England, Wales, and Northern Ireland. An Update to the Baseline Report - 2011. Health Protection Agency Centre for Infections, London; 2011.
• [4]Tuberculosis in the UK: Annual Report on Tuberculosis Surveillance in the UK, 2013. Public Health England, London; 2013.
• [5]Tuberculosis Surveillance and Monitoring in Europe 2013. ECDC, Stockholm; 2013.
• [6]Hahne SJM, Veldhuijzen IK, Wiessing L, Lim T-A, Salminen M, van de Laar M: Infection with hepatitis B and C virus in Europe: a systematic review of prevalence and cost-effectiveness of screening. BMC Infect Dis 2013, 13:181. BioMed Central Full Text
• [7]Hargreaves S, Carballo M, Friedland JS: Screening migrants for tuberculosis - where next? Lancet Infect Dis 2009, 9:139-140.
• [8]Bothamley GH, Rowan JP, Griffiths CJ, Beeks M, McDonald M, Beasley E, van den Bosch C, Feder G: Screening for tuberculosis: the port of arrival scheme compared with screening in general practice and the homeless. Thorax 2002, 57:45-49.
• [9]Ormerod LP: Further evidence supporting programmatic screening for, and treatment of latent TB Infection (LTBI) in new entrants to the UK from high TB prevalence countries. Thorax 2013, 68:201.
• [10]Pareek M: Evaluation of immigrant tuberculosis screening in industrialize countries. Emerg Infect Dis 2012, 18(9):1422-1429.
• [11]Pareek M, Watson JP, Ormerod LP, Kon OM, Woltmann G, White PJ, Abubakar I, Lalvani A: Screening of immigrants in the UK for imported latent tuberculosis: a multicentre cohort study and cost-effectiveness analysis. Lancet 2011, 11:435-444.
• [12]Pareek M: Tuberculosis screening of migrants to low-burden nations: insights from evaluation of UK practice. Eur Respir J 2011, 37(5):1175-1182.
• [13]Veldhuijzen IK, Toy M, Hahne SJM, de Wit GA, Richardus JH: Screening and early treatment of migrants for chronic hepatitis B virus infection is cost-effective. Gastroenterology 2010, 13(2):522-530.
• [14]Increasing the Uptake of HIV Testing Among Black Africans in England. NICE, London; 2011.
• [15]Collaborative TB Strategy for England: 2014–2019. For Consultation. PHE, London; 2014.
• [16]Quantitative Assessment of Visitor and Migrant Use of the NHS in England. Exploring the Data. Summary Report. Prederi, London; 2013.
• [17]Stagg HR, Jones J, Bickler G, Abubakar I: Poor uptake of primary healthcare registration among recent entrants to the UK: a retrospective cohort study. BMJ Open 2012, 2:e001453. doi: 10.1136/bmjopen-2012-001453
• [18]Hargreaves S, Holmes AH, Saxena S, Eliahoo J, Friedland JS: Charging systems for migrants in primary care: the experiences of family doctors in a high-migrant area of London. J Travel Med 2008, 15:13-18.
• [19]Census: Aggregate Data (England and Wales). 2011.
• [20]Griffiths C, Sturdy P, Brewin P, Bothamley G, Eldridge S, Martineau A, MacDonald M, Ramsay J, Tibrewal S, Levi S, Zumla A, Feder G: Educational outreach to promote screening for tuberculosis in in primary care: a cluster randomised controlled trial. Lancet 2007, 369(9572):1528-1534.
• [21][http:/ / www.strobe-statement.org/ fileadmin/ Strobe/ uploads/ checklists/ STROBE_checklist_v4_cross-sectional .pdf] webcite STROBE Statement - Checklist of Items That Should Be Included in Reports of Cross-Sectional Studies. .
• [22]Brewin P, Jones A, Kelly M, McDonald M, Beasley E, Sturdy P, Bothamley G, Griffiths C: Is screening for tuberculosis acceptable to immigrants? A qualitative study. J Public Health 2006, 28:253-260.
• [23]Seedat F, Hargreaves S, Friedland JS: Engaging new migrants in infectious disease screening: a qualitative semi-structured in-depth interview study of UK migrant community health-care leads. PLoS One 2014, 9(10):e108261. doi:10.1371/journal.pone.0108261
• [24]Thomas F, Aggleton P, Anderson J: “If I cannot access services, then there is no reason for me to test”: the impacts of health service charges on HIV testing and treatment amongst migrants in England. AIDS CARE 2010, 22(4):526-531.
• [25]Sustaining Services and Ensuring Fairness in the NHS. Implementation Outline. DoH, London; 2014.
• [26]Hargreaves S, Friedland JS, Gothard P, Saxena S, Millington H, Eliahoo J, Le Feuvre P, Homes A: Impact on and use of health services by international migrants: questionnaire survey of inner city London A&E attenders. BMC Hlth Serv Res 2006, 6:153-158. http://www.biomedcentral.com/1472-6963/6/153 BioMed Central Full Text