Baggaley Rebecca F, Martin Christopher A, Eborall Helen C, Gohar Marjan, Aziz Kashif, Fahad Muhammad, Hills George, Patel Mayur, Stephenson Iain, Haldar Pranabashis, Abubakar Ibrahim, Toovey Oliver, White Helena A, Jones William, Pierce Mark, Vyas Rachna, Sanganee Nilesh, Trevithick Caroline, Griffiths Chris, Pareek Manish
Development Centre for Population Health, University of Leicester, Leicester, UK.
NIHR Leicester Biomedical Research Centre (BRC), University of Leicester, Leicester, UK.
EClinicalMedicine. 2025 May 30;84:103253. doi: 10.1016/j.eclinm.2025.103253. eCollection 2025 Jun.
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.
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.
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.
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.
NIHR, Gilead Sciences.
移民患慢性感染的风险增加，且预后较差，更有可能出现就诊延迟的情况。早期诊断和管理可降低发病率、死亡率及后续感染传播。
我们评估了一种综合筛查方法的有效性，该方法用于在英国莱斯特的患者首次在全科医疗（GP）机构登记时，对移民进行结核（TB）感染、HIV、乙型肝炎病毒（HBV，采用乙肝表面抗原检测）和丙型肝炎病毒（HCV，采用抗体检测及确认性PCR检测）感染的筛查，通过检测阳性率、新诊断病例数以及与医疗护理的关联数来评估。
在2016 - 2019年被转诊进行检测的4004名移民GP患者中，检测阳性率分别为：HIV为0.48%（17/3545，95%CI 0.30 - 0.77%），HBV为3.34%（117/3502，95%CI 2.80 - 3.99%），HCV为0.18%（6/3402，95%CI 0.08 - 0.38%），IGRA为19.38%（496/2560，95%CI 17.89 - 20.95%）。在就诊的IGRA阳性患者中，7%（31/437）患有活动性TB，92%（403/437）患有潜伏性TB感染。17例（55%）活动性TB、397例（99%）潜伏性TB、71例（61%）HBV、6例（35%）HIV和5例（83%）HCV感染为新诊断病例。新诊断患者与医疗护理的关联率很高。98%（390/397）的新潜伏性TB患者接受了化学预防，其中94%（366/390）开始治疗，这些患者中95%（346/366）完成了疗程。新诊断的HIV、HBV和HCV患者的随访率分别为100%（6/6）、97%（69/71）和100%（5/5）。
这项针对近期移民的首个基于初级医疗的联合感染检测项目发现，潜伏性/活动性TB、HBV和HIV的检测阳性率很高，这些感染的新诊断病例数量可观，且与医疗护理的关联良好。为影响英国的筛查指南，必须评估其成本效益以及在其他初级医疗环境中的可接受性。
英国国家卫生研究院（NIHR）、吉利德科学公司。
