• Latent tuberculosis
• migration
• screening
• tuberculosis

We read with interest the editorial by Moore-Gillon et al,1 which advocated a more comprehensive system of immigrant screening/treatment for latent tuberculosis infection (LTBI) as a means of augmenting tuberculosis (TB) control in the UK.

A recent comprehensive, national evaluation of local TB services/primary care organisations(PCOs) in the UK, which provides key insights into UK screening practices,2 found that the existing National Institute for Health and Clinical Excellence (NICE) guidance from 2006 was often not followed. While all TB services would follow-up new entrants referred to them with suspected active TB, only just over half attempt to screen migrants with normal chest x-rays for LTBI; more pertinently it was those local TB services/PCOs that served the highest TB burden areas that were four times less likely to undertake LTBI screening. There was also deviation from NICE guidance in the LTBI screening methods employed (tuberculin skin test vs interferon gamma release assays). Therefore, there is a need for effective national coordination if a new strategy is to be effective in controlling TB.

Furthermore, while we agree with Moore-Gillon et al on the need to change policy, we believe that there needs to be an expanded evidence base to determine which specific immigrants we should screen, where we should screen them and what tools we should use as well as a change in attitude about the importance of tackling LTBI in migrants to drive down the UK's TB burden. Crucially, in an increasingly cost-constrained environment, comprehensive health-economic analyses will be required to determine which changes in policy are justified.