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Community-based testing of migrants for infectious diseases (COMBAT-ID): observational cohort study measuring the
Rebecca F Baggaley1,2,3,4,5, Christopher A Martin1,2,4,6,7, Helen C Eborall8
1Development Centre for Population Health, University of Leicester, Leicester, UK.
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.
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