Introduction Since July 2014, the London Borough of Newham has offered latent tuberculosis (TB) screening to all recent migrants (residing in the UK less than 5 years), aged 16–50 years, from countries with a TB incidence of greater than 150/100 000 cases/year. All migrants are offered an interferon gamma-release assay (IGRA) when registering with a general practitioner. Active TB is excluded by the GP using chest radiography, blood tests and clinical examination. All IGRA positive patients are tested for HIV, Hepatitis B and C. All patients without underlying liver disease, Hepatitis B, C or HIV infection and those who are not immunosuppressed are offered treatment for LTBI with Rifampicin and Isoniazid for 3 months in primary care. Patients with positive results not meeting the above exclusion criteria are referred to the local secondary care service using a standardised referral protocol.
We conducted a retrospective study reviewing records of all patients referred to secondary care from the LTBI screening programme.
Results From July 2014 to March 2015, a total of 5683 patients were offered screening. 3272 proceeded to IGRA testing of which 866 were positive. Of these patients, 138 were referred to the TB clinic. The most common reasons for referral were symptoms suggestive of active TB (26%), abnormal liver function tests (19%) before and after initiation of treatment, an abnormal chest radiograph (CXR) (10%), Pregnancy or breastfeeding (9%), Hepatitis B or C infection (7%) or previously treated latent or active TB (7%). Of those referred, 11 patients were found to have active disease. 6 patients had mediastinal lymphnode TB, 4 pulmonary and one patient had TB of the knee.
Conclusion Screening for latent tuberculosis in primary care has identified a significant of number of cases of active Tuberculosis, particularly mediastinal TB.