title: Latent tuberculous screening of recent migrants attending language classes: a cohort study and cost analysis.
abstract: England's national tuberculosis (TB) strategy recommends testing for and treatment of latent tuberculous infection (LTBI) among new migrants. Programmatic testing occurs in primary care, which may be inaccessible for some individuals. Current strategies could therefore be complemented by screening in other settings.
  
  
  
  To investigate the feasibility and effectiveness of LTBI screening in a community college.
  
  
  
  A cohort study using observational data collected during the pilot study. Eligible students from high-incidence countries provided consent and were tested with a single-step interferon-gamma release assay (IGRA) and enrolled. We used single and multivariable analyses to estimate screening effectiveness and to explore different subgroups. We included costs from a UK National Health Service perspective.
  
  
  
  Screening uptake was 75% and treatment completion was 85%. Of 440 students, 71 (16%) were LTBI-positive; two had active TB. There was an association of positivity with age and incidence in the country of origin. Three incidence thresholds met our criteria for screening: countries with >40, >100 and >200 cases per 100 000 population, plus students from sub-Saharan Africa.
  
  
  
  We found that LTBI screening can be offered effectively in a community college, and could be a complement to primary care-based programmes in low-incidence countries.
authors.affiliation: Public Health England (PHE) Centre for Infectious Disease Surveillance and Control, London.
authors.forename: M
authors.initials: M
authors.lastname: Usdin
authors.affiliation: Heart of England Foundation Trust, Birmingham, UK.
authors.forename: M
authors.initials: M
authors.lastname: Dedicoat
authors.affiliation: PHE West Midlands, Birmingham, UK.
authors.forename: R
authors.initials: R
authors.lastname: Gajraj
authors.affiliation: South and City College Birmingham, Birmingham, UK.
authors.forename: P
authors.initials: P
authors.lastname: Harrison
authors.affiliation: Birmingham & Solihull TB Service, Heart of England National Health Service Trust, Birmingham, UK.
authors.forename: H
authors.initials: H
authors.lastname: Kaur
authors.affiliation: PHE West Midlands, Birmingham, UK.
authors.forename: K
authors.initials: K
authors.lastname: Duffield
authors.affiliation: PHE West Midlands, Birmingham, UK.
authors.forename: C-L
authors.initials: CL
authors.lastname: Walker
authors.affiliation: PHE West Midlands, Birmingham, UK.
authors.forename: Y
authors.initials: Y
authors.lastname: Akram
authors.affiliation: PHE West Midlands, Birmingham, UK.
authors.forename: V
authors.initials: V
authors.lastname: Aiyedun
authors.affiliation: PHE West Midlands, Birmingham, UK.
authors.forename: H
authors.initials: H
authors.lastname: Mohamed
authors.affiliation: Public Health England (PHE) Centre for Infectious Disease Surveillance and Control, London, UK; Centre for Infectious Disease Surveillance and Control, PHE, London, UK; Centre for Infectious Disease Epidemiology, University College London, UK; London, National Institute for Health Research Health Protection Research Unit in Respiratory Infections, Imperial College London, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Zenner
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D004739:England / Q000453:epidemiology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015994:Incidence; D059425:Interferon-gamma Release Tests / Q000191:economics / Q000379:methods*; D055985:Latent Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D010865:Pilot Projects; D013334:Students / Q000706:statistics & numerical data; D014171:Transients and Migrants / Q000706:statistics & numerical data*; D055815:Young Adult