Tuberculosis in recent migrants to the UK: Examining new-entrant health screening and delays to diagnosis from the patient's perspective.

英国近期移民的结核病：从患者的角度审视新移民的健康筛查和诊断延误。

• 批准号: MR/M014517/1
• 负责人: Jessica Potter
• 金额: $ 25.46万
• 依托单位: Queen Mary University of London
• 依托单位国家: 英国
• 项目类别: Fellowship
• 财政年份: 2015
• 资助国家: 英国
• 起止时间: 2015 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FM014517%2F1
• 关键词: Tuberculosis; recent; migrants; UK; Examining

BACKGROUNDTuberculosis (TB) is an infectious disease. In 2012 there were 9.3 million new cases of active TB worldwide and over 9,000 in the UK. TB is transmitted by coughing from a patient with disease affecting the lungs. For those in contact with them, who themselves breath in the TB bacteria, 3 things might happen: their immune system may clear the infection completely; they may become unwell with TB (active TB); or the bacteria may enter the body and remain there 'dormant' - latent TB infection. Approximately one third of the world's population is thought to be infected with TB. Of these, approximately 1 in 10 will go on to develop active TB at some point in their life. Diagnosis and prophylactic treatment of latent TB can reduce an individual's risk of developing active disease in the future and is an important tool in reducing rates of TB both in the UK and elsewhere.AIMThis project will examine two patient journeys: the first is their journey from migration to arrival in the UK and experience of TB screening; the second will explore illness pathways from initial symptoms of TB to health-seeking behaviours and healthcare encounters. The study will be set in east London, now the 'TB capital of Western Europe'. Barts Health NHS Trust is the largest TB service in the country and treats approximately 700 new cases of TB per annum.TB SCREENINGTo reduce the spread of infectious TB several strategies for TB screening exist in the UK. Some of these processes have recently changed. Screening when someone enters the country is being been phased out. A new system of pre-entry screening in a migrant's country of origin has been implemented. Some GPs screen patients when they register. However, most TB screening programmes target active TB which affects the lungs therefore missing the 50% of TB which affects other parts of the body and also missing latent TB infection. It is also unclear what proportion of patients who develop active TB in this country do not undergo screening because they fall outside these pathways. It is our impression that TB screening is not sufficiently well organised.ACCESS TO HEALTHCAREMany patients with undiagnosed active TB attend Emergency Departments rather than their GP. Some have been unwell for months. When people who have recently moved to this country do become unwell, they often struggle to access healthcare services. This can cause a delay in diagnosis, resulting in wider spread of disease, higher costs, greater illness and even death. METHODSParticipants for this study will be recruited from TB clinics. The research will be conducted by a doctor who has significant experience working within the local community and with TB patients. Patients will be asked for their written consent and information will be collected from a questionnaire and an interview. Patients will be asked to tell their stories from migration through to diagnosis without interruption. To ensure the specific issues surrounding TB screening and healthcare access are covered, a limited number of more direct semi-structured interview questions will be used to 'fill in the gaps' of the patient's narrative.OUTCOMESThis project will provide detailed insight into the limitations of the current systems for TB screening and healthcare provision for migrants. Outcomes will include specific and detailed policy recommendations about how the organisation of these services could be more effective and accessible. The results will highlight key strategic areas which should be targeted with a view to reducing the disease burden of TB in the UK. The findings will also be applicable to migrant groups within other settings (and with other infectious diseases) and to TB screening in major urban centres within countries of low TB prevalence.

背景结核病(TB)是一种传染病。2012年，全球有930万新的活动性结核病病例，英国有9000多例。肺结核是通过患有肺部疾病的患者咳嗽传播的。对于与他们有接触的人来说，他们自己呼吸了结核病细菌，可能会发生三种情况：他们的免疫系统可能完全清除感染；他们可能会对结核病(活动性结核病)感到不适；或者细菌可能进入人体并在那里保持“休眠”-潜伏的结核病感染。世界上大约三分之一的人口被认为感染了结核病。在这些人中，大约十分之一的人会在一生中的某个时候发展为活动性结核病。潜在结核病的诊断和预防性治疗可以降低个人未来患活动性疾病的风险，是降低英国和其他地方结核病发病率的重要工具。AIM这个项目将研究两个患者的旅程：第一个是他们从移民到到达英国的旅程以及结核病筛查的经历；第二个将探索从结核病的初始症状到寻求健康行为和医疗保健接触的疾病路径。这项研究将在伦敦东部进行，这里现在是“西欧的结核病之都”。Barts Health NHS Trust是英国最大的结核病服务机构，每年治疗约700例新病例。结核病筛查为了减少传染性结核病的传播，英国有几种结核病筛查策略。其中一些过程最近发生了变化。当有人进入美国时，筛查正在被逐步取消。在移民原籍国实施了一项新的入境前筛查制度。一些全科医生在患者注册时进行筛查。然而，大多数结核病筛查方案针对的是影响肺部的活动性结核病，因此漏掉了影响身体其他部位的50%的结核病，也漏掉了潜在的结核病感染。目前还不清楚，在这个国家，有多大比例的活动性结核病患者因为不在这些途径之外而没有接受筛查。我们的印象是结核病筛查的组织不够完善。许多未确诊的活动性结核病患者去急诊科而不是他们的全科医生。有些人几个月来一直身体不适。当最近搬到这个国家的人确实身体不适时，他们往往难以获得医疗服务。这可能会导致诊断延迟，导致疾病更广泛的传播，更高的成本，更大的疾病，甚至死亡。方法这项研究的参与者将从结核病诊所招募。这项研究将由一位在当地社区和结核病患者中拥有丰富工作经验的医生进行。患者将被要求书面同意，信息将从问卷和访谈中收集。患者将被要求不间断地讲述他们从迁移到诊断的故事。为了确保围绕结核病筛查和医疗保健获得的具体问题得到覆盖，将使用有限数量的更直接的半结构化采访问题来填补患者叙述的空白。OUTCOMES该项目将详细了解当前系统在结核病筛查和为移民提供医疗保健方面的局限性。成果将包括关于如何使这些服务的组织更有效和更容易获得的具体和详细的政策建议。结果将突出应针对的关键战略领域，以期减少英国结核病的疾病负担。这些研究结果也将适用于其他环境中的移徙群体(以及患有其他传染病的移民群体)以及结核病低流行率国家内主要城市中心的结核病筛查。

项目成果

6.5-O3Getting migrants animated about latent tuberculosis infection: developing novel educational tools to raise awareness and improve uptake of testing in a national programme in the UK

6.5-O3让移民了解潜在结核病感染：开发新颖的教育工具，以提高认识并提高英国国家计划中检测的采用率

• DOI: 10.1093/eurpub/cky047.225
• 发表时间: 2018
• 期刊: European Journal of Public Health
• 影响因子: 4.4
• 作者: Burman M

The Visitor and Migrant Cost Recovery Programme - A threat to health?

游客和移民成本回收计划 - 对健康构成威胁吗？

• DOI: 10.21203/rs.2.11966/v3
• 发表时间: 2020
• 作者: Potter J

Charging of overseas visitors in England and universal health coverage: a cross-sectional analysis of NHS trusts.

英国海外游客收费和全民健康保险：NHS 信托机构的横断面分析。

• DOI: 10.1093/pubmed/fdaa207
• 发表时间: 2022
• 期刊: Journal of public health (Oxford, England)
• 作者: Dobbin J

S27 Have recent changes to health policies increased diagnostic delay amongst migrant patients with active tb?

S27 最近卫生政策的变化是否增加了流动结核病患者的诊断延迟？

• DOI: 10.1136/thoraxjnl-2017-210983.33
• 发表时间: 2017
• 作者: Potter J

Failure to challenge discriminatory behaviour is complicity.

未能挑战歧视行为就是同谋。

• DOI: 10.1136/bmj.m147
• 发表时间: 2020
• 期刊: BMJ (Clinical research ed.)
• 作者: Potter J