Recently (and especially since the COVID-19 pandemic) fewer people have been coming forward for latent TB screening, despite being directly contacted and invited in for screening. Individuals have expressed concern that they are being scammed or that they will be charged a fee for the test. This is increasing the risk of future TB outbreaks in the community because, although people with latent TB do not feel sick and cannot spread infection, there is still a risk they will develop active TB later in life.

In north central London, TB screening for migrants from high-incidence countries is a two-stage process:

• stage one: chest X-ray to screen for active TB (infectious/symptomatic): most migrants have this before arriving in the UK (as part of the visa application process)
• stage two: a blood test to screen for latent TB (not infectious/asymptomatic).

Practices are asked to help by doing the following:

• identify recent migrants from high-incidence countries during their registration process and explain that they will be contacted by the TB service and offered screening. Please emphasise that:
  • screening is free.
  • the test is different from the chest X-ray they had before entering the country: it screens for latent 'sleeping' TB that could 'wake up' and become active
  • if their blood test is positive, latent TB is easier to treat than active TB, requiring a course of antibiotics. This treatment is also free and can be accessed regardless of immigration status.
• Please provide patients with the information leaflet in Downloads.

Stage two of the screening process (Latent TB Screening) is managed by the NCL TB Team based at Whittington Health.

The team uses Flag 4 data (generated when a recent migrant registers with a GP practice) to directly contact individuals at high risk of having a latent TB infection to invite them in for screening. The target population for latent TB testing will follow the national eligibility criteria (see Resources).

Eligibility Criteria

Inclusions

• born or spent ≥ six months in high TB-incidence country (>150/100,000) 
• entered the UK within the last five years (including where entry was via other countries such as within EU/EEA)
• aged 16-35 years
• not previously been screened for TB in the UK.

How to Refer

Locations

North Middlesex University Hospital

Royal Free Hospital

Whittington Hospital