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

Hargreaves, S; Seedat, F; Car, J; Escombe, R; Hasan, S; Eliahoo, J; Friedland, JS (2014) 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 Infect Dis, 14. p. 657. ISSN 1471-2334 https://doi.org/10.1186/s12879-014-0657-2
SGUL Authors: Hargreaves, Sally

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Abstract

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.

Item Type: Article
Additional Information: © Hargreaves et al.; licensee BioMed Central Ltd. 2014 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Keywords: Adolescent, Adult, Aged, Cross-Sectional Studies, Emigrants and Immigrants, Female, HIV Infections, Hepatitis B, Hepatitis C, Humans, Latent Tuberculosis, London, Male, Mass Screening, Middle Aged, Prevalence, Primary Health Care, Young Adult, Microbiology, 0605 Microbiology, 1103 Clinical Sciences, 1108 Medical Microbiology
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: BMC Infect Dis
ISSN: 1471-2334
Language: eng
Dates:
DateEvent
3 December 2014Published
24 November 2014Accepted
Publisher License: Creative Commons: Attribution 4.0
PubMed ID: 25466442
Go to PubMed abstract
URI: http://sgultest.da.ulcc.ac.uk/id/eprint/110111
Publisher's version: https://doi.org/10.1186/s12879-014-0657-2

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