Tuberculosis active case finding based on symptom screening among irregular immigrants, refugees and asylum seekers in Rome and Milan, Italy

Background: In Italy tuberculosis (TB) is now largely concentrated in vulnerable groups such as migrants and in urban settings. Italy has no TB screening policy for new entrants. Objective: To assess coverage and yield of a TB case-finding programme for migrants based on symptom screening and TB history conducted in Milan at “Naga”, a non-governmental out-patient clinic for irregular immigrants, and in Rome at “SaMiFo”, a health service for asylum seekers/refugees. Methods: A questionnaire on symptoms (cough, haemoptysis, fever, night sweats, weight loss, chest pain) and TB history (contact with TB patients or prior diagnosis of TB) was administered to patients presenting for any medical reason. Individuals reporting at least one symptom or TB history were referred to the TB clinic for diagnostic workup. Results: From January to December 2013, 2320 subjects (78.5% m, median age 34 yrs) were enrolled: refugees/asylum seekers were mostly from Senegal or Mali and irregular migrants were from Egypt, Morocco and Romania. 85.7% of them sought primary medical care due to symptoms other than protocol-defined TB symptoms. Screening coverage was over 75%. Among 420 (18.1%) subjects positive to the questionnaire, 230 were referred to the TB clinics. Of them, 57 (24.8%) did not present for evaluation. TB was diagnosed in 4 individuals representing 0.2% of those screened and 2.3% of those evaluated for TB. Conclusion: The overall yield of this intervention was in the range reported for other TB screening programmes for migrants. Our study shows the potential effectiveness of using an inexpensive tool to promote early TB diagnosis in vulnerable populations.