title: Lessons learnt from TB screening in closed immigration centres in Italy.
abstract: Between June 2012 and December 2013 Médecins Sans Frontières launched a pilot project with the aim of testing a strategy for improving timely diagnosis of active pulmonary TB among migrants hosted in four centres of identification and expulsion (CIE) in Italy.
  
  
  
  This is a descriptive study. For active TB case finding we used an active symptom screening approach among migrants at admission in four CIE's. Here we describe the feasibility and the yield of this programme.
  
  
  
  Overall, 3588 migrants were screened, among whom 87 (2.4%) had a positive questionnaire. Out of 30 migrants referred for further investigations, three were diagnosed as having TB, or 0.1% out of 3588 individuals that underwent screening. Twenty-five (29%, 25/87) migrants with positive questionnaires were not referred for further investigation, following the doctors' decision; however, for 32 (37%, 32/87) migrants the diagnostic work-out was not completed. In multivariate analyses, being over 35 years (OR 1.7; 95% CI 1.1-2.6) and being transgender (OR 4.9; 95% CI 2.1-11.7), was associated with a positive questionnaire.
  
  
  
  TB screening with symptom screening questionnaires of migrants at admission in closed centres is feasible. However, to improve the yield, follow-up of patients with symptoms or signs suggestive for TB needs to be improved.
authors.affiliation: Médecins Sans Frontières, Operational Centre Brussels, Italian Mission anna_crepet@yahoo.it.
authors.forename: Anna
authors.initials: A
authors.lastname: Crepet
authors.affiliation: Médecins Sans Frontières, Operational Centre Brussels, Italian Mission.
authors.forename: Ernestina
authors.initials: E
authors.lastname: Repetto
authors.affiliation: Médecins Sans Frontières, Operational Centre Brussels, Italian Mission.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Al Rousan
authors.affiliation: Department of Epidemiology, National Institute for Infectious Diseases "L. Spallanzani", IRCCS Rom, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Sané Schepisi
authors.affiliation: Department of Epidemiology, National Institute for Infectious Diseases "L. Spallanzani", IRCCS Rom, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Girardi
authors.affiliation: Department of Infectious Diseases, ARNAS, Ospedale Civico-Benfratelli, Palermo, Italy.
authors.forename: Tullio
authors.initials: T
authors.lastname: Prestileo
authors.affiliation: Villa Marelli Institute, Niguarda Ca' Granda Hospital- Milan-Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Codecasa
authors.affiliation: Médecins Sans Frontières, Operational Centre Brussels, Italian Mission.
authors.forename: Silvia
authors.initials: S
authors.lastname: Garelli
authors.affiliation: Department of Infectious Diseases, ARNAS, Ospedale Civico-Benfratelli, Palermo, Italy Centre of Research for Effectiveness and Appropriateness in Medicine, Palermo, Italy Biomedical Department of Internal Medicine and Subspecialties, University of Palermo, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Corrao
authors.affiliation: Department of Epidemiology, National Institute for Infectious Diseases "L. Spallanzani", IRCCS Rom, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ippolito
authors.affiliation: Médecins Sans Frontières, Operational Centre Brussels, Operational Research Unit.
authors.forename: Tom
authors.initials: T
authors.lastname: Decroo
authors.affiliation: Médecins Sans Frontières, Operational Centre Brussels, Italian Mission.
authors.forename: Barbara
authors.initials: B
authors.lastname: Maccagno
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000458:organization & administration*; D008875:Middle Aged; D010865:Pilot Projects; D012036:Refugees / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014171:Transients and Migrants / Q000706:statistics & numerical data*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D055815:Young Adult
keywords: Immigration detention centres; Italy; Migrants; Questionnaire; Screening; Tuberculosis