Abubakar, I

Boogaard, JVD

De Vries, G

English

UCL Discovery

The Lancet Regional Health - Western Pacific 10 (2021) 100154 Contents lists available at ScienceDirect The Lancet Regional Health - Western Pacific journal homepage: www.elsevier.com/locate/lanwpc Commentary The importance of systematic data collection, monitoring and evaluation of tuberculosis screening programmes of migrants arriving in low-incidence countries Gerard de Vries a , ∗, Jossy van den Boogaard a , Ibrahim Abubakar b a Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands b Institute for Global Health, University College London, London, United Kingdom a r t i c l e i n f o Article history: Received 6 April 2021 Accepted 6 April 2021 Available online 27 April 2021 momTpbiibtcoO2tAttcppcntatuaArw5ctl  g  ta(131ccttm(sscch2(The report of the Lancet Migration and Health Commission sur- ises that with a billion people on the move, this subject is one f the defining issues of our time [1] . Human population move- ent has been temporarily altered by the COVID-19 pandemic. ravel and migration will return, with some adaptation to a post- andemic world. The higher risk of infectious diseases such as tu- erculosis (TB) in migrants from high TB burden countries to high- ncome settings is widely recognised [2] . In some settings, such as n Western European nations and in Australia, TB in the foreign orn can exceed three-quarters of cases. Furthermore, TB is one of he diseases where morbidity and mortality is higher in migrants ompared to the host population. Consequently, the TB screening f migrants is conditionally recommended by the World Health rganization (WHO); the recommendation was unchanged in the 021 update [3] . The specific details of the combination of tools o use in such screening programmes remains a matter for debate. ny screening programme should include a monitoring and evalua- ion plan and results should inform programme managers to assess he performance of the TB screening components. In The Lancet Regional Health – Western Pacific , James Trauer and olleagues analyse the data of the Australian migrant TB screening rogramme [4] . The study cohort included 2,381,217 applicants for ermanent, provisional and humanitarian visas to Australia who ompleted their offshore or onshore immigration medical exami- ation between July 1, 2014 and June 30, 2017. Physical examina- ion and chest X-ray were the most prominent components of the ssessment for TB. Around two-thirds (66.2%) of applications were DOI of original article: 10.1016/j.lanwpc.2021.100135 ∗ Corresponding author at: Centre for Infectious Disease Control, National Insti- ute for Public Health and the Environment, Bilthoven, the Netherlands. E-mail address: gerard.de.vries@rivm.nl (G. de Vries). loatttps://doi.org/10.1016/j.lanwpc.2021.100154 666-6065/© 2021 The Author(s). Published by Elsevier Ltd. This is an open access article http://creativecommons.org/licenses/by-nc-nd/4.0/ ) ndertaken offshore and one third (33.7%) within Australia. Visa pplicants were predominantly young adults from Asian countries. nalysis of the 1263 cases diagnosed by the screening programme, evealed several important findings. First, the overall prevalence as relatively low with 53.0 cases per 10 0.0 0 0 applicants (95% CI 0.2-56.1), i.e. 1887 persons needed to be screened to detect one ase. The TB prevalence among visa applicants differed substan- ially by countries categorized according to WHO-estimated preva- ence, and varied from 6.8 per 10 0.0 0 0 (95% CI 4.5-10.2) for mi-rants from countries with a TB prevalence of < 40 per 10 0,0 0 0o 198.4 (95% CI 180.7-217.7) for migrants from countries with  prevalence ≥350 per 10 0,0 0 0. Second, the prevalence was 8.0 6.5-9.9) times higher in humanitarian visa applicants (183 per 0 0,0 0 0) compared to temporary visa applicants, and 25.7 (21.9- 0.2) fold higher in people with past TB treatment (2141 per 0 0,0 0 0). Third, age-standardized TB prevalence in offshore appli- ants closely matched the WHO-estimated TB prevalence in the ountries of origin. The study of Trauer and colleagues presents to our knowledge he largest dataset on TB screening of migrants to a single coun- ry, and nicely illustrates the value of systematic data collection, onitoring and evaluation of screening. In Europe, four countries Italy, the Netherlands, Sweden and United Kingdom) have recently et up a European database on TB and Latent TB Infection (LTBI) creening of migrants to provide greater statistical power and to ontribute to migrant TB screening evidence. This database in- ludes modules on eligible migrants for screening, screening data, inkage to care, treatment completion and reactivation (the latter nly for LTBI diagnoses) [5] . The low TB prevalence among visa applicants found by Trauer nd colleagues impacts the effectiveness and cost-effectiveness of he intervention. Their study provides suggestions to improve the under the CC BY-NC-ND license G. de Vries, J.v.d. Boogaard and I. Abubakar The Lancet Regional Health - Western Pacific 10 (2021) 100154 ewmafplaaasTotcoa  gobmgtWeiiDR      [  ffectiveness, e.g. by limiting screening to migrants from countries ith a TB prevalence above a certain cut-off, as is practised in ost European countries [ 6 , 7 ]. The observation that humanitarian pplicants, such as refugees and asylum seekers, have a high risk or TB clearly indicates that these individuals need priority in a TB revention and care programme. Their study is not reporting on inkage-to-care issues which may not be available for persons di- gnosed with TB outside Australia, but could be more readily avail- ble for those diagnosed in Australia. It is important to report on ll steps of the screening process, from eligibility of persons for creening to the treatment completion of people diagnosed with B. Trauer and colleagues also raise the importance of reactivation f overseas-acquired LTBI, and scaling up post-migration interven- ions to reduce the TB burden. The epidemiology in low-incidence ountries indeed shows that a substantial number and proportion f migrants develop TB in the host country several months or years fter migration [ 8 , 9 ]. In Australia, LTBI testing and treatment of mi-rants is currently limited to children aged two to ten years and to lder migrants with a history of close contact with a TB patient, ut could be extended to people from high TB burden countries to ove towards TB elimination. Trauer and colleagues conclude that support for TB control pro- rammes overseas and preventive interventions are likely to have he greatest impact on the TB burden in high-income countries. e fully agree with them, that these investments will highly ben- fit the people in the countries concerned, as well as the high- ncome countries that may receive migrants from these countries n time [10] . 2 eclaration of Competing Interest IA acted as WHO STAG Chair ended in 2019. eferences [1] Abubakar I , Aldridge RW , Devakumar D , et al. The UCL-lancet commis-sion on migration and health: the health of a world on the move. Lancet 2018;392:2606–54 . [2] European Centre for Disease Prevention and Control Assessing the burden of key infectious diseases affecting migrant populations in the EU/EEA. Stock- holm: ECDC; 2014 . [3] WHO consolidated guidelines on tuberculosis Module 2: screening - systematic screening for tuberculosis disease. Geneva: World Health Organization; 2021 . [4] Trauer JM, Williams B, Laemmle-Ruff I, et al. Tuberculosis in migrants to Aus- tralia: outcomes of a national screening program. Lancet Reg Health West Pac 2021. doi: 10.1016/j.lanwpc.2021.100135 . [5] Öhd JN , Lönnroth K , Abubakar I , et al. Building a European database to gathermulti-country evidence on active and latent TB screening for migrants. Int J Infect Dis 2019(80S):S45–9 . [6] Aldridge RW , Yates TA , Zenner D , White PJ , Abubakar I , Hayward AC . Pre-entryscreening programmes for tuberculosis in migrants to low-incidence countries: a systematic review and meta-analysis. Lancet Infect Dis 2014;14:1240–9 . [7] Kunst H , Burman M , Arnesen TM , et al. Tuberculosis and latent tuberculousinfection screening of migrants in Europe: comparative analysis of policies, surveillance systems and results. Int J Tubercul Lung Dis 2017;21:840–51 . [8] van den Boogaard J , Slump E , Schimmel HJ , van der Hoek W , van den Hof S ,de Vries G . High incidence of active tuberculosis in asylum seekers from Er- itrea and Somalia in the first 5 years after arrival in the Netherlands. Emerging Infect Dis 2020;26:675–81 . [9] Kristensen KL , Ravn P , Petersen JH , et al. Long-term risk of tuberculosisamong migrants according to migrant status: a cohort study. Int J Epidemiol 2020;49:776–85 . 10] Menzies NA , Bellerose M , Testa C , et al. Impact of effective global tuberculosiscontrol on health and economic outcomes in the United States. Am J Respir Crit Care Med 2020;202:1567–75 . 

The importance of systematic data collection, monitoring and evaluation of tuberculosis screening programmes of migrants arriving in low-incidence countries

https://discovery.ucl.ac.uk/10132446/1/Abubakar_The%20importance%20of%20systematic%20data%20collection%2C%20monitoring%20and%20evaluation%20of%20tuberculosis%20screening%20programmes%20of%20migrants%20arriving%20in%20low-incidence%20countries_VoR.pdf

The importance of systematic data collection, monitoring and evaluation of tuberculosis screening programmes of migrants arriving in low-incidence countries

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