title: Screening for latent TB, HIV, and hepatitis B/C in new migrants in a high prevalence area of London, UK: a cross-sectional study.
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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Imperial College London, Department of Medicine, Section of Infectious Diseases and Immunity, Hammersmith Hospital Campus, 8th Floor Commonwealth Building, DuCane Road, London, W12 ONN, UK. s.hargreaves@imperial.ac.uk.
authors.forename: Sally
authors.initials: S
authors.lastname: Hargreaves
authors.affiliation: Imperial College London, Department of Medicine, Section of Infectious Diseases and Immunity, Hammersmith Hospital Campus, 8th Floor Commonwealth Building, DuCane Road, London, W12 ONN, UK. f.seedat@imperial.ac.uk.
authors.forename: Farah
authors.initials: F
authors.lastname: Seedat
authors.affiliation: Hammersmith and Fulham Centres for Health, Hammersmith Hospital, Hammersmith, London. josip.car@imperial.ac.uk.
authors.forename: Josip
authors.initials: J
authors.lastname: Car
authors.affiliation: Hammersmith and Fulham Centres for Health, Hammersmith Hospital, Hammersmith, London. rod.escombe@nhs.net.
authors.forename: Rod
authors.initials: R
authors.lastname: Escombe
authors.affiliation: Hammersmith and Fulham Centres for Health, Hammersmith Hospital, Hammersmith, London. s.hasan@nhs.net.
authors.forename: Samia
authors.initials: S
authors.lastname: Hasan
authors.affiliation: Imperial College London, Department of Medicine, Section of Infectious Diseases and Immunity, Hammersmith Hospital Campus, 8th Floor Commonwealth Building, DuCane Road, London, W12 ONN, UK. j.eliahoo@imperial.ac.uk.
authors.forename: Joseph
authors.initials: J
authors.lastname: Eliahoo
authors.affiliation: Imperial College London, Department of Medicine, Section of Infectious Diseases and Immunity, Hammersmith Hospital Campus, 8th Floor Commonwealth Building, DuCane Road, London, W12 ONN, UK. j.friedland@imperial.ac.uk.
authors.forename: Jon S
authors.initials: JS
authors.lastname: Friedland
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D006509:Hepatitis B / Q000175:diagnosis* / Q000453:epidemiology; D006526:Hepatitis C / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D055985:Latent Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology; D008131:London / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care; D055815:Young Adult