Prevalence of and risk factors for active tuberculosis in migrants screened before entry to the UK: a population-based cross-sectional study

Author/s: Robert Aldridge, Dominik Zenner, Peter White, Morris Muzyamba, Miranda Loutet, Poonam Dhavan, Davide Mosca, Andrew Hayward, Ibrahim Abubakar
Language: English
Publication Type: Scientific Report (Journal)(External)

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Background: An increasing number of countries with low incidence of tuberculosis have pre-entry screening programmes for migrants. We present the fi rst estimates of the prevalence of and risk factors for tuberculosis in migrants from 15 high-incidence countries screened before entry to the UK.

Methods: We did a population-based cross-sectional study of applicants for long-term visas who were screened for tuberculosis before entry to the UK in a pilot programme between Oct 1, 2005, and Dec 31, 2013. The primary outcome was prevalence of bacteriologically confi rmed tuberculosis. We used Poisson regression to estimate crude prevalence and created a multivariable logistic regression model to identify risk factors for the primary outcome.

Findings: 476 455 visa applicants were screened, and the crude prevalence of bacteriologically confi rmed tuberculosis was 92 (95% CI 84–101) per 100 000 individuals. After adjustment for age and sex, factors that were strongly associated with an increased risk of bacteriologically confi rmed disease at pre-entry screening were self-report of close or household contact with an individual with tuberculosis (odds ratio 11·6, 95% CI 7·0–19·3; p<0·0001) and being an applicant for settlement and dependant visas (1·3, 1·0–1·6; p=0·0203).

Interpretation: Migrants reporting contact with an individual with tuberculosis had the highest risk of tuberculosis at pre-entry screening. To tackle this disease burden in migrants, a comprehensive and collaborative approach is needed between countries with pre-entry screening programmes, health services in the countries of origin and migration, national tuberculosis control programmes, and international public health bodies.

Funding: Wellcome Trust, Medical Research Council, and UK National Institute for Health Research. Copyright © Aldridge et al. 

The Lancet