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. 2023 Oct 12;62(4):2202396.
doi: 10.1183/13993003.02396-2022. Print 2023 Oct.

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

Dominik Zenner  1   2   3   4 , Daniella Brals  3   4 , Joanna Nederby-Öhd  5 , Dee Menezes  6 , Robert Aldridge  6 , Sarah R Anderson  7 , Gerard de Vries  8 , Connie Erkens  9 , Valentina Marchese  10 , Alberto Matteelli  10 , Morris Muzyamba  7 , Job van Rest  9 , Ineke Spruijt  9 , John Were  11 , Giovanni Battista Migliori  12 , Knut Lönnroth  5 , Frank Cobelens  3   4 , Ibrahim Abubakar  11
Affiliations

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

Dominik Zenner et al. Eur Respir J. .

Abstract

Background: The World Health Organization 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 and 2018 in 2 302 260 screening episodes among 2 107 016 migrants to four countries, the programmes identified 1658 TB cases (yield 72.0 (95% CI 68.6-75.6) per 100 000). In logistic regression analysis, we found associations between TB screening yield and age (≥55 years: OR 2.91 (95% CI 2.24-3.78)), being an asylum seeker (OR 3.19 (95% CI 1.03-9.83)) or on a settlement visa (OR 1.78 (95% CI 1.57-2.01)), close TB contact (OR 12.25 (95% CI 11.73-12.79)) and higher TB incidence in the country of origin. We demonstrated interactions between migrant typology and age, as well as country of origin. For asylum seekers, the elevated TB risk remained similar above country of origin incidence thresholds of 100 per 100 000.

Conclusions: Key determinants of TB yield included close contact, increasing age, incidence in country of origin 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 the country of origin. The high, country of origin-independent TB risk in asylum seekers above a 100 per 100 000 threshold could reflect higher transmission and re-activation risk of migration routes, with implications for selecting populations for TB screening.

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Conflict of interest statement

Conflict of interest: D. Zenner reports grants from Barts Charity, La Caixa Foundation and the European Commission, outside the submitted work. D. Menezes reports grants through project E-DETECT, Work Package 6. V. Marchese reports grant support and travel compensation from E-DETECT TB. The other authors have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Yield from tuberculosis (TB) screening (colours) and total number of screens (numbers) performed by screening programmes.
FIGURE 2
FIGURE 2
Yield from tuberculosis (TB) screening and World Health Organization (WHO) estimated TB incidence rate (2021) in WHO world regions [1]: African Region (AFRO), Region of the Americas (AMRO), Eastern Mediterranean Region (EMRO), European Region (EURO), South-East Asia Region (SEARO) and Western Pacific Region (WPRO). Colours denote TB yield.
See this image and copyright information in PMC

Comment in

References

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    1. World Health Organization . WHO Consolidated Guidelines on Tuberculosis: Module 2: Screening: Systematic Screening for Tuberculosis Disease. 2021. www.who.int/publications-detail-redirect/9789240022676 Date last accessed: 27 March 2023.

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