Expert Panel: [ARCHIVED] Tuberculosis Among Migrants

When: Jan. 16, 2017 - Jan. 20, 2017 | Community: MDR-TB Treatment & Prevention  

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Panelists of Tuberculosis Among Migrants and GHDonline staff

How can we best measure and analyze the TB burden among migrants?

Posted: 16 Jan, 2017   Recommendations: 10   Replies: 22

Dear colleagues,

I hope you are doing fine. We are staring our one week panel discussion on a very important topic of TB among migrants. Today we are focusing on measuring and analyzing the burden of TB among migrants. Here we shall discuss both active and latent TB. To my view both are important. Detecting active TB is crucial to ensure early and adequate treatment and breaking the transmission cycle among migrants and avoid possible transmission from migrants to the local communities. We shall also not forget that migrants are not always having a higher TB rates than the local population, but based on the major flow of migrants, it is often the case that TB rates are higher in the country of origin than in the host country. Much less has attention has been paid to timely detection of latent TB which can avert development of the disease should a recent infection occur.

Should the receiving country have a good screening and surveillance system in place, the numerator is well reported, however most often the challenge is to know the denominator to be able to calculate the prevalence or incidence rate.

I will be posting summary of several publications today, but would like to encourage all community members and other panelists to share their views and experiences in measuring and analyzing the TB burden among migrants.

All the best,
Masoud

Replies

 

Bruno Hanson Replied at 2:27 AM, 16 Jan 2017

No one really analyze the burden in a systematic way, we don't collect the data.

Masoud Dara, MD Panelist Replied at 3:05 AM, 16 Jan 2017

Many countries do record and report TB among foreign born individuals. The latest data from ECDC and WHO Regional Office surveillance report indicate TB cases of foreign origin represent 26.8% of all TB cases reported from EU/EEA countries and 2.1% from non EU/EEA countries. Among EU/EEA countries, specific proportions of foreign-origin TB cases ranged from below 1% in Bulgaria, Poland and Romania to above 80% in Cyprus, Iceland, Luxembourg, Malta, Norway and Sweden. Surveillance system shall capture the key determinants of the disease, particularly history of migration or being born in another country than the host country.

All the best,
Masoud

Attached resource:

Jessica Potter Replied at 3:44 AM, 16 Jan 2017

Dear Masoud and others,

My name is Jess Potter. I am a respiratory doctor with a special interest in TB and am currently doing a PhD looking at the experiences of migrants to the uk who have active tuberculosis of their migratory journey, illness and health service accessibility.

My question is: which factors are important determinants of both the disease and diagnostic delay in relation to a person's migratory journey?

From my point of view, whilst the literature has pointed towards labels such as undocumented status and forced migration as factors which impair health services accessibility I have two key issues with these:

First is the need to ensure that by collecting these labels individuals are not identified in the process of seeking help when they are unwell because of government policies designed to deport undocumented individuals.

Second is the meaning of these labels and the work they do. Migrant journeys are often complex and they may fluctuate for example between the categories we have ascribed to them. For example: a person who arrives with an appropriate visa but fails
to renew it will move from documented to undocumented; a skilled migrant doctor may struggle to gain employment within his profession and find work as an unskilled labourer instead.

I look forward to anyone's comments on this in particular and on the forum topic in general.

Jess

Jessica Potter
Clinical Lecturer & MRC Research Fellow

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Masoud Dara, MD Panelist Replied at 7:41 AM, 16 Jan 2017

Dear Jess,

Thank you very much for your contribution in the discussion. Good to know you are doing a PHD on the same very subject. Among the factors contributing to TB infection and disease development are:

-TB rates in the home country, individuals coming from higher TB prevalence countries carry higher risk of TB, particularly in the first 2-5 years after migration.
- Duration of travel and travel conditions. Some people may have been detained in a third/transit county and have travelled or stayed in precarious conditions. Another factor is the age and other risk factors for example young children or elderly or people living with HIV or diabetes are more prone to active disease development after infection.
- Awareness, perceptions and equitable access to health care during transit, upon arrival and after arrival. If people are not fully aware of TB symptoms or fear deportation, or are stigmatized or don't have full access to diagnosis, treatment and care, their disease may not be detected and consecutively develop progressive disease or even drug resistance form if so partial/self treatment.

You have probably read the study by Tomas et al. Tuberculosis in Migrant Populations. A Systematic Review of the Qualitative Literature. I copy the conclusion for easy access:

"The results of this review indicate that immigrants’ knowledge of and attitudes towards TB are largely built on their previous experiences. Even though the immigrant populations were heterogeneous, there were common challenges amongst groups, such as the perception of TB as being highly contagious and severe, frequent lack of treatment adherence, obstacles to effective communication with health providers and/or anticipated and enacted stigma that hindered treatment and isolated the patient.

However, these similarities should not obscure the needs of specific groups – defined in terms of cultural references and socio-economic factors including social networks and living conditions at host countries. Immigrants require appropriate information on TB aetiology and transmission tailored to different language abilities, levels of knowledge and beliefs systems, in addition to screening strategies and health care provision that are adapted to their particular traditions, values and social relationships, in order to guarantee information, screening, diagnosis and adherence to treatment.

Beyond escalating current interventions and increasing monitoring of TB incidence and prevalence in immigrant populations it is crucial to understand immigrants’ perceptions of TB and the specific obstacles that they face when accessing the health system, seeking a diagnosis and adhering to a treatment programme. "

We will be discussing some of these issues in more details during our panel discussion as we proceed, but today we wish to focus more on the steps to measure the burden, but I fully agree that these are so important and have direct impact on detection and consecutively on our understanding of the burden.


All the best,
Masoud

Attached resource:

Bruno Hanson Replied at 8:09 AM, 16 Jan 2017

Since the conflict in the Middle-East, we have seen an increase in the number of migrants and asylum seekers from there as well as other countries. I want to know which nationalities we shall screen for TB?

Colleen Daniels Replied at 9:32 AM, 16 Jan 2017

Hi all,
The Stop TB Partnership Global Plan to End TB outlines a number of key targets to be achieved by 2020, or 2025 at the latest. The plan refers to people who are vulnerable, under-served, or at risk as TB “key populations” and provides models for investment packages that will allow countries to achieve the 90-(90)-90 targets. As part of this work STP developed a series of guides on TB key and vulnerable populations (http://www.stoptb.org/communities/). The guide on mobile populations (migrants, refugees and internally displaced people) reviews the current situation, barriers, opportunities as well as recommendations to address their needs. Barriers such as the legal status of migrants at their destination, discriminatory policies, stigma, insecure working arrangements, police harassment as well as availability and access to health services are all issues that need to be addressed. Possible responses to some barriers include the need for migrants to be aware of what services are currently available to them; for governments to develop services that are culturally and linguistically appropriate and for migrants to be able to access health care both in sending and receiving communities. Please see more in the guide at:
http://www.stoptb.org/assets/documents/resources/publications/acsm/KP_Mobile_...

Cheers,
Colleen

Attached resources:

Masoud Dara, MD Panelist Replied at 9:58 AM, 16 Jan 2017

Dear Bruno,

I don't know which setting you are based at. You may wish to read the papers published at European Respiratory Journal. The Netherlands did a through analysis of the TB detection among asylum seekers and concluded that there is a low yield of screening among asylum seekers coming from countries with a TB incidence of less than 50 per 100,000 population. The Belgians did a similar study and reached to a different conclusion.

http://erj.ersjournals.com/content/47/6/1870.long?utm_source=TrendMD&utm_medi...

http://erj.ersjournals.com/content/48/4/1253

Preventing and controlling tuberculosis among refugees in Europe: more is needed
http://erj.ersjournals.com/content/48/1/272

In short, you need to consider screening for TB among all individuals coming from a country with a relatively higher TB rate than yours. The real question is to choose a threshold above which, to conduct active screening. There is no simple answer to that. In addition to TB rate in the country of origin, multiple factors play role including socioeconomic status of the migrants coming to your country, how long and which means they have used to travel and under which conditions they have been or currently are living. One needs to make decision based on ongoing operations. get the database sorted correctly and accurately so that it is capturing both numerator and denominator, so that it would be possible to analyze the findings on a regular basis and make informed decision. To set a database, it is crucial to get rapid access to the examination results, have systems to avoid double reporting. A sound coordination at national and even international level is needed without jeopardizing confidentiality and patient right. In some settings Xpert-MTB Rif is being piloted to detect TB among symptomatic individuals.

All the best,
Masoud

Gebreamlak Gidey Abebe Replied at 10:16 AM, 16 Jan 2017

Great thanks for sharing this topic for panel discussion on How can we best measure and analyze the TB burden among migrants.In developing country like Ethiopia this might be a national problem since a millions of migrants were came from Eritrea, south Sudan,Somalia and others. therefore, measuring and analyzing the TB burden so crucial and i am interesting to earn more experiences from my brothers and stors working in glob.
thanks again for sharing this mandatory issues.

Gebreamlak Gidey, Maternal and Rh specialist, Lecturer at Aksum University, CHS department of Midwifery, Tigray, Ethiopia.

Masoud Dara, MD Panelist Replied at 11:55 AM, 16 Jan 2017

Thank you Gebreamlak,

Your note is a good reminder to all of us that there are many countries with limited resources which are providing significant care and support for migrants and refugees across the world.

All the best,
Masoud

Elizabeth Glaser Replied at 12:20 PM, 16 Jan 2017

Dear Masoud,
One question I have about assessing TB burden is , when a person is entering from a country that may be considered lower risk, is the person asked about previous work or movements to other countries or internal areas that might be considered high risk?

Here in Malawi , there is movement of males to and from South Africa for work, and movement back and forth across local borders as those in rural parts of Zambia and Mozambique try to access HIV care and or work in Malawi. There is also a lot of internal migration with people from rural areas working in urban areas or doing seasonal work in the tea estates and then returning home after the harvest. So have seasonal movement of people from high to low TB risk districts.

Fluid borders can make it quite difficult to do any kind of surveillance. The new national HIV treatment guidelines , which are not fully implemented as yet, have a controversial protocol which calls for every HIV positive person in the 10 districts with the highest TB burden to go on INH for life. Yes - INH for life. In lieu of being able to adequately track , test , and treat, the government is opting to provide life long TB prophylaxis to those already receiving ART . While it might protect those stably on ART and lower the overall TB burden, it may not reduce risk in those economic migrants.

A recent PhD grad that I know focused on assessing the overall burden of TB in immigrants to the US for her dissertation, with one aspect being a collaboration with TCN on bridge management of mobile populations.. A paper from the larger work has already been published: Tschampl CA, Garnick DW, Zuroweste E, Razavi M, Shepard DS. Use of Transnational Services to Prevent Treatment Interruption in Tuberculosis-Infected Persons Who Leave the United States.Emerg Infect Dis. 2016 Mar; 22(3): 417–425. doi: 10.3201/eid2203.141971

Will get in touch with her and encourage her to participate in this discussion.

Elizabeth

Masoud Dara, MD Panelist Replied at 1:03 PM, 16 Jan 2017

Dear colleagues,

I highly recommend reading the BMC Medicine paper "The impact of migration on tuberculosis epidemiology and control in high-income countries: a review" by Manish Pareek, Christina Greenaway, Teymur Noori, Jose Munoz and Dominik Zenner:

The authors reviewed TB in high income countries and analyzed the burden TB in foreign-born, migrant populations and then discussed the drivers of the current TB epidemiology in these populations focusing on migration patterns, the importance of reactivation of latent tuberculosis infection as compared to the burden of imported active TB and molecular genotyping data underpinning these studies. They then went on to discuss, in detail, the methods, outcomes, and cost-effectiveness of the different TB control strategies in place for migrant populations. They showed that foreign-born individuals, in 2013, made up over half of all TB cases (median 52.0 %; IQR 31.4–73.9 %) with incidence rates 8.7-18.4 times that seen in the local-born population. I am copying their key messages and conclusions for your easy access:

Quote
"Key messages about tuberculosis and migration in high-income countries
• Tuberculosis continues to be a public health concern in high-income countries
• Tuberculosis burden in high-income countries is primarily amongst the foreign-born, migrant population
• The reasons underlying this burden are the interaction of migration from high TB burden countries and the reactivation of remotely acquire latent tuberculosis infection in the first five years after arrival
• Genotyping data suggests that there is relatively little transmission in migrant communities in the receiving country
• Methods of TB control in migrant population have historically focused on identifying active tuberculosis but the yields for this remain relatively low
• Screening migrants for latent tuberculosis infection may have a higher yield although implementation may be difficult
• The health economics of screening migrants for active and/or latent tuberculosis is a topic of much debate
• Targeted pre-arrival screening for active TB and post arrival screening for latent tuberculosis infection in migrants from intermediate/high TB burden settings may provide the most cost-effective solution
• Implementation of programmatic screening is limited by uptake, acceptance and completion of therapy"
Unquote

Conclusions: Quote
"In this review we have comprehensively brought together the literature with respect to all aspects of tuberculosis and migration. Tuberculosis in high-income countries continues to be a cause of morbidity and mortality – particularly amongst individuals who have been born overseas in high TB burden, low-income countries and migrated to high-income countries. The reasons for the burden of disease in the foreign-born, migrant, population are primarily due to migration from high TB burden settings and the reactivation of remotely-acquired latent TB infection. As a consequence there is increasing focus on how best to enhance TB control through the coordinated screening of migrants for TB. Whilst most countries focus on screening migrants for active TB, this has a relatively low yield on its own and it is likely that the most effective and cost-effective means of screening migrants for TB will comprise multiple, inter-linking elements: pre-arrival screening for active TB and targeted post arrival screening for LTBI in migrants from intermediate/high TB burden settings. However, the programmatic implementation of migrant screening is potentially hampered by limited uptake, acceptance and completion of therapy. There is an urgent need for further coordinated research in this area to inform future national and international guidance." Unquote

Attached resource:

Bontle Mbeha Replied at 1:18 PM, 16 Jan 2017

Thanks

Dylan Tierney Replied at 2:28 PM, 16 Jan 2017

There seems to be a point emerging out of today’s discussion that the approach to measuring TB prevalence in migrants is different between high-income and low-income country settings.

It is well understood that a significant percentage of the TB burden in high-income countries is due to TB among migrants. The scope of the issue in low-income countries seems to be less well understood, due to poor documentation and porous borders.

I would hypothesize that the efficiency of screening active or latent TB in migrants (# migrants screened/# migrants) is much higher in high-income countries that in low-income countries. Comparing those two situations, however, seems unfair because of the disparity in resources that can be brought to bear on the problem.

I wonder if we have ways to compare screening efficiency (i.e., measuring the burden of TB) between similar countries with similar income levels. This type of comparison would allow us to determine what countries are conducting screening the most efficiently and what approaches they are using.

Any insights from experts?

Kedir Abdella Abdulsemed Replied at 2:31 PM, 16 Jan 2017

Dear all Colleagues,

Of all thanks to post this hot timely issue for discussion. I can suggest
TB issue among immigrant has multiple impacts on migrant them selves as
they travel with team in most crowded condition without having sufficient
diet, shelters and every other basic physiological needs for long enough
time for reactivation of latent TB in to active TB plus enough time of
exposure to acquire infection from close contact . Immigrants are commonly
passing via multiple communities or they are crossing the border of
different countries before they are arriving to the host countries. They
also be distributed to different countries means that the final destination
is even not the same for all of them.
Therefore, the point is to determine the burden of TB among immigrant when
and where we shall start investigation or screening for TB among this
venerable population? Do all the the countries where they pass through as
transition or end up as destination have taken this issue in to account
when designing national TB control plan or do they all have the capacity
even to screen them for active TB? Can we also trace all immigrants? What
is the UN direction or policy in this regards.? What is the role of TB
researchers/ TB Scientific communities or expertise s role?

Thus, these and other important questions should be address to have at
least some information about TB burden among immigrants. To me for this
discussion I would like to emphasize to researchers role in this regards.
I suggests researches from academic, research institute and industry
environment etc should take initiatives to conduct research in multiple
sectors at least to show the problem as real problem to nations, policy
makers and other stake holders. Depending on how deep the problem is the
research question in this regard is also multi-directional.
Example: /what is current practice? do the countries those currently
destination for most immigrants have included TB investigation among
immigrants? If not what are the challenges( human resource, technology,
difficulty to address them etc). Do we have scientific reviews or evidence
so far about this issue?.
Therefore, to sum up it needs to have answer systematic scientific
researches even before determining the burden.

Kind regards,
Kedir

--

Kedir Abdella Abdulsemed(BSc,MSc)
MBS student at Maastricht Universitry
Skype: kedirab2
alternative Email:

Masoud Dara, MD Panelist Replied at 4:23 PM, 16 Jan 2017

Thank you very much Elizabeth,

Seasonal migration is also a known phenomenon in the eastern Europe, where people travel for several months, often live in very precarious and overcrowded conditions to be able to send money back home and return after a while only for few months until they go back for work in the host country. We will discuss this in the coming days, but there is an increasing need to ensure there is a sound and sustainable cross border TB prevention, control and care mechanisms so that people get full treatment till recovery.
I agree with your statement that the history of transit and places visited before arrival are crucial, but I doubt the countries consider this systematically unless for a pre-planned migration. Good to encourage your PHD graduate to participate in the discussion, we would love to hear about her work.

Masoud Dara, MD Panelist Replied at 5:18 PM, 16 Jan 2017

Dear Kedir,

Thank you very much for your excellent questions. Let me start the dialogue and hopefully other colleagues also share their views and expertise.

1) When and where we shall start investigation or screening for TB among this venerable population?

There are minimum requirements in order to be able screen the migrants adequately. In a war zone or several flood or earthquake, for example, priorities are trauma and stabilizing the injured and provide water and sanitation, but as soon as it is possible to provide primary health care, one need to do symptomatic TB screening of people. Therefore, with the condition that the basic health care can be provided, one needs to consider embarking on symptomatic screening, this can include cough triage or looking for the very ill people to provide them care they need and further investigate if they have TB. Now if people are on move and are transiting a country, it can be nightmare to perform even this simple triage, but this holds true with any other health intervention. We shall not forget that migrants like other people may suffer from other diseases including high blood pressure, diabetes and very importantly mental health disorders like PTSD if they are coming from conflict zone, so comprehensive health care shall be provided and screening for communicable diseases at least with symptomatic survey and medical examination shall be provided. Should the situation be more stable and lets stay, people are staying for at least a couple of days in asylum seeker centre or a camp, possibilities of laboratory exam or chest xray shall be considered. this is particularly important as people are mostly staying in very overcrowded conditions and one missed TB case can infect many others, particularly the children are mostly vulnerable.

2) Do all the the countries where they pass through as transition or end up as destination have taken this issue in to account when designing national TB control plan or do they all have the capacity even to screen them for active TB?

No, not all countries are prepared, even in European countries where large number of migrants and refugees travel, due to large number of people, it is not fully possible to perform such interventions. We did a survey in collaboration with the Euroepan Respiratory Society to document policies and practices across Europe, the result of which you can read here indicating serious gaps including funding, and incoherent policies even in the neighboring countries. file:///C:/Users/daram/Downloads/Dara%20M%20et%20al%20%20Eur%20Respir%20J%202016.pdf

3) Can we also trace all immigrants?

It is not possible to trace all migrants, there are many who are not documented and may avoid screening and health care services, particularly if they don't trust the system and fear deportation, in addition, except few countries where all people with TB are by law required to adhere to treatment irrespective of their residence or nationality, they may simply walk out with an active TB and never be found again, It is therefore very important to engage the migrant communities and involve NGOs, while respecting patients' confidentiality, providing them the necessary treatment and care.

4) What is the UN direction or policy in this regards.?

World Health Organization and International Organization of Migration as well as United Nations High Commissioner for Refugees work together with all other UN agencies. Access to quality health care including prevention, treatment and care is to provided to all including migrants. Under the Sustainable Development Goals and particularly Goal 3, countries have committed to universal health coverage. We will discuss these in the coming days and post the relevant papers.

5) What is the role of TB researchers/ TB Scientific communities or expertise s role?

Scientific committee and researchers have important role to play to help with developing further evidence which can inform policies. There are still many questions unanswered which by the end of this panel discussion we would summarize.

All the best,
Masoud

Attached resource:

Ruth MCNERNEY Replied at 1:14 AM, 17 Jan 2017

For those interested the UK has excellent records on the country of birth of TB patients, including how long they have been in the UK before TB emerged. Information is contained in the annual TB reports available from the Public Health England website https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/581...
Guidance for screening migrants can also be found there. https://www.gov.uk/search?q=tuberculosis&show_organisations_filter=true
The epidemiology/demographics varies across migrant groups, some of whom arrived in the 1950's versus others who arrived in more recent times and for different reasons. It is usually assumed that TB is persons born overseas is reactivation of latent TB but it may also be the result of travel to the home country or local transmission from a visitor, or ongoing transmission within the community.
The national strategy which includes screening can be found at https://www.gov.uk/government/publications/collaborative-tuberculosis-strateg...
The people with the most expertise in this area are TB Alert http://www.tbalert.org/ They provide training for heath professionals and NGOs, support for patients, information etc.

18 months ago I moved from London, UK (the TB capital of Western Europe) to Cape Town (a global capital of TB) where roughly one in a hundred people have TB and where we are witnessing transmission of incurable TB. Interestingly immigration rules here are tighter than in the UK - to get a work visa I had to provide a clear chest x-ray although I have not previously lived in the high TB burden country. I want to echo the comments of others: the spread of TB via migration within high burden countries and across countries in Africa and other high burden regions is a huge problem that needs to be addressed urgently. If IGRA screening and treatment of latent TB is not practical or affordable in these settings we need another strategy.

To add a cynical footnote - if it is the fear of TB spreading into Europe and North America that keeps the dollars for TB flowing then we have to work harder to make people understand that eradicating TB in Africa is the solution, not blaming and stigmatizing immigrates. After all Africa was relativity TB free until the Europeans arrived!

Ruth McNerney

Ruth MCNERNEY Replied at 5:42 AM, 17 Jan 2017

Coincidentally the latest update on TB from Public Health England has just arrived in my in-box. Please find attached.
Ruth McNerney

Attached resource:

Pierre Bush, PhD Replied at 2:35 PM, 19 Jan 2017

Dear Masoud,
Thank you for initiating this discussion panel. Tuberculosis is a real burden among migrants. Not only those who have the disease, but also among migrants in some professions such as healthcare. When I migrated in USA, we were screened for TB through chest Xray. Everything was fine. In 2003, I had a PPD at the University of TN Health Science center as a mandatory test for healthcare professionals. It was positive, because I had BCG when I was a child. It was hard to convince the Clinic staff that the Positivity was due to BCG. I fought hard not to be On INH. Since then, I have to take a chest Xray each year, or have a TB Spot test. The burden of Tuberculosis among migrants is real. Many refugees live in precarious conditions, where they do not have good nutrition and the screening for TB is difficult to be undertaken till they are given a chance to resettle in developed countries.

Attached resource:

Elizabeth Glaser Replied at 6:54 PM, 19 Jan 2017

Pierre,
Perhaps information has changed, but my understanding was that people remotely vaccinated with BCG were unlikely to have a false positive TST due to cross reactivity with BCG.

In particular an adult that received a single dose of BCG as an infant and has a TST result greater than 10mm is likely to have a true positive. While it could be possible that repeated skin testing could boost TST reactivity in people that had received BCG that would not apply with your initial positive TST results.

People with previous BCG and a positive TST are suspected to have a true positive if (1) they are the contact of a person known to be actively ill with TB;(2) was born in or lives in a TB high burden country; or (3) is regularly exposed to TB high burden populations.

In many cases health care workers fit into category 3, and if you were born and raised in a high burden country then category 2 and 3 or 1,2, and 3 might well apply. If you wanted more definitive information, IGRA testing might clarify your status but I don't think it was unreasonable of your school to err on the side of caution and assume that you might have LTBI.

Elizabeth

Pierre Bush, PhD Replied at 9:14 PM, 19 Jan 2017

Hi Elizabeth,
Thank you for the response. I understood the school concerns. The information we used at the university's clinic was from the CDC guidelines. Later, at another institution, IGRA was used instead of a second PPD to clear the status. I have realized that several clinicians are not aware of the guidelines and the testing protocol.

Attached resource:

Ayaan Gedi Replied at 9:23 AM, 20 Jan 2017

Dear all,

I just wanted to share the LTBI tool kit developed by TB Alert for our national LTBI testing and treatment programme for new migrants. This tool kit has been well received by health care provides and gives a good over view of the core components of the programme. The viability and success of this national testing programme greatly depends the engagement and support from local health stakeholders which in our case includes Clinical Commissioning Groups (CCGs), General Practitioners (GPs), local TB control boards, secondary care services (hospitals), and non profit agencies such as TB Alert.

As you may already know in England systematic testing and treatment of new migrants for TB is one of 10 key actions set our our national TB strategy and NHS England has allocated funding to support this programme for five years. Our programmatic efforts focuses on 59 geographic areas (with the highest TB burden in England and targets new migrants 16-35 years of age who arrived in the UK with the past 5 years from countries with a TB incidence >=150/100,000 ( including all Sub Saharan Africa). Further details on additional eligibility criteria and evidence based rational for selecting this population cohort can be found in the link provided below. The most recent update on the national strategy has already been shared and it shows that out of the 59 priority regions in England, 48 are now systematically identifying and testing new migrants.

Attached resources:

This Expert Panel is Archived.

While this Expert Panel is no longer active, we invite you to review and recommend past replies and resources. Membership for this Expert Panel is closed, but we hope you'll join us in one of the many communities on GHDonline.

Panelists of Tuberculosis Among Migrants and GHDonline staff