Pre-entry screening programmes for tuberculosis in migrants to low-incidence countries: A systematic review and meta-analysis

Robert W. Aldridge*, Tom A. Yates, Dominik Zenner, Peter White, Ibrahim Abubakar, Andrew C. Hayward

*Corresponding author for this work

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77 Citations (Scopus)

Abstract

Background: Several high-income countries have pre-entry screening programmes for tuberculosis. We aimed to establish the yield of pre-entry screening programmes to inform evidence-based policy for migrant health screening. Methods: We searched six bibliographic databases for experimental or observational studies and systematic reviews, which reported data on migrant screening for active or latent tuberculosis by any method before 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: We identified 15 unique studies with data for 3 739 266 migrants screened pre-entry for tuberculosis between 1982 and 2010. Heterogeneity was high for all primary outcomes. After stratification by prevalence in country of origin, heterogeneity was reduced for culture-confirmed and smear-confirmed cases. Yield of culture-confirmed cases increased with prevalence in the country of origin, and summary estimates ranged from 19.7 (95% CI 10.3-31.5) cases identified per 100 000 individuals screened in countries with a prevalence of 50-149 cases per 100 000 population to 335.9 (283.0-393.2) per 100 000 in countries with a prevalence of greater than 350 per 100 000 population. Interpretation: Targeting high-prevalence countries could result in the highest yield for active disease. Pre-entry screening should be considered as part of a broad package of measures to ensure early diagnosis and effective management of migrants with active tuberculosis, and be integrated with initiatives that address the health needs of migrants. Funding: Wellcome Trust, UK National Institute for Health Research, Medical Research Council, Public Health England.

Original languageEnglish
Pages (from-to)1240-1249
Number of pages10
JournalThe Lancet Infectious Diseases
Volume14
Issue number12
DOIs
Publication statusPublished - 2014

Bibliographical note

Funding Information:
DZ is head of the tuberculosis screening unit at Public Health England and has shared responsibilities for quality assurance within the UK pre-entry screening programme. PJW has research funding from Otsuka SA for a retrospective study of multidrug-resistant tuberculosis treatment in several eastern European countries. TAY has participated in political advocacy projects that aimed to maintain and improve access to National Health Service services for migrants in the UK and has worked on studies that received support from Sanofi, GlaxoSmithKline, and Pasante. RWA, IA, and ACH declare no competing interests.

Publisher Copyright:
© 2014 Aldridge et al. Open Access article distributed under the terms of CC BY.

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