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Thorax 67:A86 doi:10.1136/thoraxjnl-2012-202678.192
  • Poster sessions
  • Diagnosis and management of TB

P51 Reduced Effectiveness of the Primary-Care Registry For Targeted LTBI Screening of High Risk Immigrants with HIV Co-Infection

  1. P Haldar
  1. Institute for Lung Health, Glenfield Hospital, Leicester, United Kingdom

Abstract

Introduction The impact of screening for latent tuberculosis infection (LTBI) in immigrants for tuberculosis (TB) prevention in the UK is dependent on effective strategies for identifying at-risk groups. Here we investigate effectiveness of the primary-care (PC) registry to identify immigrants for enrolment to LTBI screening at the time of GP registration, based on their HIV status.

Methods We performed a 11-year retrospective cohort study of PC registrations, cross-referenced with foreign-born TB (FB-TB) notifications for immigrants entering the UK after 1999 that had HIV testing performed. We assumed LTBI screening to prevent prospective TB would be effective if notifications occurred ≥6 months after PC registration. The primary outcome was the proportion of FB-TB preventable with screening at PC registration and compared between subgroups stratified according to HIV status.

Results 624 of 857 FB-TB cases were HIV tested (72.8%) and 84 were HIV seropositive (13.4%). 56 (67%) HIV positive FB-TB cases occurred in immigrants from TB incidence regions 500/100,000. Overall 511 (63%) FB-TB cases were preventable if screened at PC registration. The proportion with unpreventable TB was significantly higher for the HIV positive compared to the HIV negative FB-TB subgroup; [19% vs 10%; RR (95% CI) = 1.89 (1.25 to2.84), p=0.003]. Compared with patients that were HIV negative, time to PC registration after UK entry was longer [median (IQR); 1515 (555–2202) days vs 415 (36–1558) days; p<0.005) and time to disease notification shorter [median (IQR); 587 (208–1182) days vs 1163 (669–1854) days, p<0.005] for HIV positive FB-TB patients.

Conclusion Targeted LTBI screening at the time of primary-care registration may be a less effective preventative strategy for HIV positive immigrants at highest TB risk. Our data supports the need to promote early registration and extended screening to include HIV and other blood-borne viruses as part of an integrated immigrant screening programme.