Country differences and determinants of yield in programmatic migrant TB screening in four European countries

INTRODUCTION: The WHO End-TB Strategy emphasises early diagnosis and screening of tuberculosis (TB) in high-risk groups, including migrants. We analysed TB yield data from four large migrant TB screening programmes to inform TB policy. METHODS: We pooled routinely collected individual TB screening episode data from Italy, the Netherlands, Sweden, and the UK under the EU Commission E-DETECT.TB grant, described characteristics of the screened population, and analysed TB case yield. RESULTS: We collected data on 2,302,260 screening episodes among 2,107,016 migrants, mostly among young adults (aged 18-44, 77.8%) from Asia (78%) and Africa (18%). There were 1,658 TB cases detected through screening with substantial yield variation (per 100,000), being 201.1 for Sweden (111.4-362.7), 68.9 (65.4-72.7) for the UK, 83.2 (73.3-94.4) for the Netherlands and 653.6 (445.4-958.2) in Italy. Most TB cases were notified among migrants from Asia (n=1,206, 75/100,000) or Africa (n=370, 76.4/100,000) and among asylum seekers (n=174, 131.5 per 100,000), migrants to the Netherlands (n=101, 61.9/100,000) and settlement visa migrants to the UK (n=590, 120.3/100,000). CONCLUSIONS: We found considerable variation in yield across programmes, types of migrants and country of origin. This variation may be partly explained by differences in migration patterns and programmatic characteristics.