Multi-infection screening for migrant patients in UK primary care: Challenges and opportunities

Perspectives on tuberculosis in migrants, refugees, and displaced populations in Europe

Finding and treating all forms of tuberculosis (TB) (latent, drug-susceptible, drug-resistant, multidrug-resistant, and extensively drug-resistant tuberculosis) among migrants, displaced populations, and refugees are important challenges facing TB control programs in Europe. Many of these populations live in poor conditions, with limited access to healthcare and TB services. Ever-increasing armed conflicts in Europe and other parts of the world continue to exacerbate rates of migration to and within Europe, with considerable implications for health services. TB in Europe is more prevalent in migrants from high TB-endemic areas, as well as those with social risk factors, including poverty and poor housing or homelessness. We provide our perspectives on recent data on TB in Europe from the World Health Organization, the European Centre for Disease Prevention and Control, the United Kingdom Health Security Agency, and other 2023-2024 reports. Despite advancements in TB screening and prevention strategies, and treatment regimens including community-based and integrated multi-disease approaches, significant challenges remain. These include variations in national policies, resource limitations, and barriers to accessing healthcare. To help address these challenges, there is a need for clearer guidance through national policies, enhanced surveillance, and proactive community engagement There is also an urgent need for more investment into TB health services in Europe for refugees, migrants, and other displaced populations.

Systematic review exploring the burden of sexually transmissible infections and bloodborne viruses in refugees and asylum seekers: insights to inform policy and practice

BACKGROUND

In 2022, the number of refugees and asylum seekers (RAS) have reached an all-time high of 40.7 million globally. The surge in RAS, coupled with their limited access to healthcare (at their home and destination countries), has led to the risk of transmitting/acquiring sexually transmissible infections (STIs) and bloodborne viruses (BBVs). This situation threatens the health of RAS and poses a public health challenge to destination countries, potentially placing a burden on healthcare systems and resources. Healthcare recommendations for screening programmes for RAS vary between countries, leading to disparities in STI/BBV screening practices on arrival. These disparities can impact early detection and treatment of STIs/BBVs, increasing the risk of onward transmission and long-term negative sequelae. Therefore, this systematic review aims to investigate the prevalence and factors associated with STIs/BBVs among RAS.

METHODS

Six databases (ie, PubMed, Embase, Scopus, Cochrane Library, Web of Science and CINAHL) were searched for observational studies reporting STIs/BBVs prevalence and/or risk factors among RAS. The inverse variance heterogeneity model with double arcsine transformation was applied to prevalence meta-analysis of STIs/BBVs by region of origin of RAS. Narrative data synthesis was undertaken to summarise risk factors associated with STIs/BBVs.

RESULTS

A total of 21 studies (n=504 432 RAS) were included. Most studies were conducted among RAS arriving in Europe (n=14), followed by North America (n=5) and Australia (n=2). The highest prevalence of HIV (1.55%; 95% CI 0.53 to 3.04), syphilis (1.29%; 95% CI 0.59 to 2.24) and hepatitis B (6.50%; 95% CI 2.29 to 12.46) were observed among RAS from sub-Saharan Africa. The highest prevalence of hepatitis C was found in RAS from Southeast Asia (3.96%; 95% CI 2.74 to 5.38) and North Africa (3.59%; 95% CI 1.33 to 6.79). The highest prevalence of chlamydia was reported among RAS from the Middle East (1.48%; 95% CI 0.00 to 4.73) and Eastern Europe (1.40%; 95% CI 0.38 to 4.96). History of STIs, torture, blood transfusion and African origin were identified as factors associated with increased prevalence of STIs/BBVs.

CONCLUSIONS

This study underscores the regional disparities in the burden of STIs/BBVs among RAS. These findings highlight the importance of targeted screening for STIs/BBVs based on the country/region of origin and individual risk factors, and implementation of mitigation measures (eg, improving healthcare access and raising awareness) tailored to their unique needs. Such measures are crucial for reducing the impact of STIs/BBVs in both RAS and host countries.

PROSPERO REGISTRATION NUMBER

CRD42024546750.

Health Catch-UP!: a realist evaluation of an innovative multi-disease screening and vaccination tool in UK primary care for at-risk migrant patients

BACKGROUND

Migrants to the UK face disproportionate risk of infections, non-communicable diseases, and under-immunisation compounded by healthcare access barriers. Current UK migrant screening strategies are unstandardised with poor implementation and low uptake. Health Catch-UP! is a collaboratively produced digital clinical decision support system that applies current guidelines (UKHSA and NICE) to provide primary care professionals with individualised multi-disease screening (7 infectious diseases/blood-borne viruses, 3 chronic parasitic infections, 3 non-communicable disease or risk factors) and catch-up vaccination prompts for migrant patients.

METHODS

We carried out a mixed-methods process evaluation of Health Catch-UP! in two urban primary healthcare practices to integrate Health Catch-UP! into the electronic health record system of primary care, using the Medical Research Council framework for complex intervention evaluation. We collected quantitative data (demographics, patients screened, disease detection and catch-up vaccination rates) and qualitative participant interviews to explore acceptability and feasibility.

RESULTS

Ninety-nine migrants were assessed by Health Catch-UP! across two sites (S1, S2). 96.0% (n = 97) had complete demographics coding with Asia 31.3% (n = 31) and Africa 25.2% (n = 25), the most common continents of birth (S1 n = 92 [48.9% female (n = 44); mean age 60.6 years (SD 14.26)]; and S2 n = 7 [85.7% male (n = 6); mean age 39.4 years (SD16.97)]. 61.6% (n = 61) of participants were eligible for screening for at least one condition and uptake of screening was high 86.9% (n = 53). Twelve new conditions were identified (12.1% of study population) including hepatitis C (n = 1), hypercholesteraemia (n = 6), pre-diabetes (n = 4), and diabetes (n = 1). Health Catch-UP! identified that 100% (n = 99) of patients had no immunisations recorded; however, subsequent catch-up vaccination uptake was poor (2.0%, n = 1). Qualitative data supported acceptability and feasibility of Health Catch-UP! from staff and patient perspectives, and recommended Health Catch-UP! integration into routine care (e.g. NHS health checks) with an implementation package including staff and patient support materials, standardised care pathways (screening and catch-up vaccination, laboratory, and management), and financial incentivisation.

CONCLUSIONS

Clinical Decision Support Systems like Health Catch-UP! can improve disease detection and implementation of screening guidance for migrant patients but require robust testing, resourcing, and an effective implementation package to support both patients and staff.

How We Treat Drug-Susceptible Pulmonary Tuberculosis: A Practical Guide for Clinicians

Tuberculosis (TB) remains one of the leading causes of morbidity and mortality worldwide and pulmonary TB (PTB) is the main variant responsible for fueling transmission of the infection. Effective treatment of drug-susceptible (DS) TB is crucial to avoid the emergence of Mycobacterium tuberculosis-resistant strains. In this narrative review, through a fictional suggestive case of DS PTB, we guide the reader in a step-by-step commentary to provide an updated review of current evidence in the management of TB, from diagnosis to post-treatment follow-up. World Health Organization and Centre for Diseases Control (CDC) guidelines for TB, as well as the updated literature, were used to support this manuscript.