Community-based testing of migrants for infectious diseases (COMBAT-ID): observational cohort study measuring the effectiveness of routine testing for infectious diseases among migrants attending primary care

Rebecca F Baggaley^{1

2

3

4

5}, Christopher A Martin^{1

2

4

6

7}, Helen C Eborall⁸, Marjan Gohar^{2

4

6}, Kashif Aziz^{6

9}, Muhammad Fahad⁶, George Hills^{6

9}, Mayur Patel¹⁰, Iain Stephenson⁶, Pranabashis Haldar^{2

4}, Ibrahim Abubakar¹¹, Oliver Toovey^{12

13}, Helena A White^{4

6}, William Jones¹⁴, Mark Pierce¹⁵, Rachna Vyas¹⁵, Nilesh Sanganee¹⁵, Caroline Trevithick¹⁵, Chris Griffiths^{16

17}, Manish Pareek^{1

2

4

6

7}

Affiliations

¹ Development Centre for Population Health, University of Leicester, Leicester, UK.
² NIHR Leicester Biomedical Research Centre (BRC), University of Leicester, Leicester, UK.
³ Department of Population Health Sciences, University of Leicester, Leicester, UK.
⁴ Department of Respiratory Sciences, University of Leicester, Leicester, UK.
⁵ Institute of Health Informatics, University College London, London, UK.
⁶ Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.
⁷ NIHR Applied Research Collaboration East Midlands, University of Leicester, Leicester, UK.
⁸ Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.
⁹ Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK.
¹⁰ NHS Leicester Integrated Care Board, Leicester, UK.
¹¹ Faculty of Population Health Sciences, University College London, London, UK.
¹² Department of Virology, University Hospitals of Leicester NHS Trust, Leicester, UK.
¹³ The College of Life Sciences, University of Leicester, Leicester, UK.
¹⁴ Department of Emergency LRI, University Hospitals of Leicester NHS Trust, Leicester, UK.
¹⁵ NHS Leicester, Leicestershire & Rutland Integrated Care Board, UK.
¹⁶ Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
¹⁷ Nuffield Department of Primary Health Care Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, UK.

PMID: 40687739
PMCID: PMC12273839
DOI: 10.1016/j.eclinm.2025.103253

Community-based testing of migrants for infectious diseases (COMBAT-ID): observational cohort study measuring the effectiveness of routine testing for infectious diseases among migrants attending primary care

Rebecca F Baggaley et al. EClinicalMedicine. 2025.

. 2025 May 30:84:103253.

doi: 10.1016/j.eclinm.2025.103253. eCollection 2025 Jun.

Authors

Affiliations

¹ Development Centre for Population Health, University of Leicester, Leicester, UK.
² NIHR Leicester Biomedical Research Centre (BRC), University of Leicester, Leicester, UK.
³ Department of Population Health Sciences, University of Leicester, Leicester, UK.
⁴ Department of Respiratory Sciences, University of Leicester, Leicester, UK.
⁵ Institute of Health Informatics, University College London, London, UK.
⁶ Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.
⁷ NIHR Applied Research Collaboration East Midlands, University of Leicester, Leicester, UK.
⁸ Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.
⁹ Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK.
¹⁰ NHS Leicester Integrated Care Board, Leicester, UK.
¹¹ Faculty of Population Health Sciences, University College London, London, UK.
¹² Department of Virology, University Hospitals of Leicester NHS Trust, Leicester, UK.
¹³ The College of Life Sciences, University of Leicester, Leicester, UK.
¹⁴ Department of Emergency LRI, University Hospitals of Leicester NHS Trust, Leicester, UK.
¹⁵ NHS Leicester, Leicestershire & Rutland Integrated Care Board, UK.
¹⁶ Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
¹⁷ Nuffield Department of Primary Health Care Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, UK.

PMID: 40687739
PMCID: PMC12273839
DOI: 10.1016/j.eclinm.2025.103253

Abstract

Background: Migrants are at increased risk of chronic infections and have poorer outcomes, being more likely to present late. Early diagnosis and management can reduce morbidity, mortality and onward infection transmission.

Methods: We evaluated the effectiveness of an integrated approach to screening migrants for exposure to tuberculosis (TB) with an interferon gamma release assay (IGRA) test, HIV, hepatitis B virus (HBV, using hepatitis B surface antigen testing) and hepatitis C virus (HCV, using antibody testing with confirmatory PCR test) infection when patients first registered with general practices (GPs) in Leicester, UK, using test yields (test positivity rates), numbers of new diagnoses and numbers linked to care.

Findings: Of 4004 migrant GP patients referred for testing 2016-2019, test yields were 0.48% (17/3545, 95% CI 0.30-0.77%, HIV), 3.34% (117/3502, 95% CI 2.80-3.99%, HBV), 0.18% (6/3402, 95% CI 0.08-0.38%, HCV) and 19.38% (496/2560, 95% CI 17.89-20.95%, IGRA). Of IGRA-positive patients attending clinic, 7% (31/437) had active TB and 92% (403/437) had latent TB infection. Seventeen (55%) active TB, 397 (99%) latent TB, 71 (61%) HBV, six (35%) HIV and five (83%) HCV infections were new diagnoses. There were high rates of linkage to care for those newly diagnosed. 98% (390/397) of new latent TB patients were offered chemoprophylaxis, of whom 94% (366/390) started treatment and of these, 95% (346/366) completed the course. 100% (6/6), 97% (69/71) and 100% (5/5) of newly HIV-, HBV- and HCV-diagnosed patients attended follow-up, respectively.

Interpretation: This first primary care-based combined infection testing programme for recent migrants found high test yields for latent/active TB, HBV and HIV, substantial numbers of new diagnoses for these infections and excellent linkage to care. To influence UK screening guidelines, its cost-effectiveness and acceptability to other primary care settings must be evaluated.

Funding: NIHR, Gilead Sciences.

Keywords: HBV; HCV; HIV; Migrant health; Primary care; Tuberculosis; Viral hepatitis.

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Conflict of interest statement

MPareek reports grants from Gilead for the current work, Sanofi, and Moderna outside the current work, and has received consulting fees from QIAGEN and Gilead. IS reports payment from Gilead (speaker fee for lecture on HIV epidemiology) and support for attending meetings (online registration for 2 international HIV meetings AIDS 2024 and Glasgow HIV conference 2024) from ViV. We report no other relationships or activities that could appear to have influenced the submitted work.

Figures

**Fig. 1**
Results of multivariable logistic regression models showing the association of age, sex and ethnicity with testing positive for HIV, HBV and IGRA tests (numbers testing positive for HCV were too low to present a meaningful analysis). Error bars represent adjusted odds ratio 95% confidence intervals. ∗The IGRA test identifies both active and latent TB infections.

**Fig. 2**
Co-infection prevalence (number of positive tests). Plot not to scale. ∗ The IGRA test used identifies both active and latent TB infections.

**Fig. 3**
Patient flow diagram: numbers of patients tested as part of the COMBAT-ID screening programme for recent (≤5 years since entry) migrants to the UK by infection type and associated outcomes. Further details are provided in the text and in Figures S2, S3 and S4, Supplementary Material, for patients testing positive for HIV, HBV and TB infection, respectively. LTBI, latent tuberculosis infection.

See this image and copyright information in PMC

References

1. ONS. Office for National Statistics . 2022. International migration, England and Wales: census 2021.https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigrati... Available at:
1. ONS. Office for National Statistics . 2022. Country of birth dataset, census 2021. Dataset ID: TS004.https://www.ons.gov.uk/datasets/TS004/editions/2021/versions/3 last updated February 2023. Available at:
1. Office for Health Improvement and Disparities, UK . 2021. Migrant health guide [collection]https://www.gov.uk/government/collections/migrant-health-guide last updated October 2023. Available at:
1. UKHSA. UK Health Security Agency Official Statistics . 2024. National quarterly report of tuberculosis in England: quarter 2, 2024, provisional data.https://www.gov.uk/government/statistics/tuberculosis-in-england-nationa... Available at:
1. UKHSA. UK Health Security Agency Official Statistics . 2023. HIV annual data tables.https://www.gov.uk/government/statistics/hiv-annual-data-tables Available at:

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Community-based testing of migrants for infectious diseases (COMBAT-ID): observational cohort study measuring the effectiveness of routine testing for infectious diseases among migrants attending primary care

Affiliations

Community-based testing of migrants for infectious diseases (COMBAT-ID): observational cohort study measuring the effectiveness of routine testing for infectious diseases among migrants attending primary care

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources