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

结核病（TB）是一种传染病。2012年，全球有930万例活动性结核病新发病例，其中英国有9,000多例。结核病是通过肺部疾病患者的咳嗽传播的。对于那些与他们接触的人来说，他们自己呼吸结核菌，可能会发生3件事：他们的免疫系统可能完全清除感染;他们可能会因结核病（活动性结核病）而感到不适;或者细菌可能进入体内并保持“休眠”-潜伏性结核病感染。据认为，世界上大约三分之一的人口感染了结核病。其中，大约十分之一的人将在他们生命中的某个时候发展为活动性结核病。潜伏性结核病的诊断和预防性治疗可以降低个人未来发展为活动性疾病的风险，是降低英国和其他地方结核病发病率的重要工具。目的本项目将研究两个患者旅程：第一个是他们从移民到抵达英国的旅程和结核病筛查的经验;第二个项目将探索从结核病的最初症状到寻求健康的行为和医疗保健接触的疾病途径。这项研究将设在东伦敦，现在是“西欧结核病之都”。Barts Health NHS Trust是英国最大的结核病服务机构，每年治疗约700例结核病新病例。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。当有人进入该国时进行的筛查正在逐步取消。在移民原籍国实施了一项新的入境前检查制度。一些全科医生在登记时对病人进行筛查。然而，大多数结核病筛查计划针对影响肺部的活动性结核病，因此错过了影响身体其他部位的50%结核病，也错过了潜伏性结核病感染。目前还不清楚在这个国家发展活动性结核病的患者中有多少比例没有接受筛查，因为他们不在这些途径之内。我们的印象是，结核病筛查组织得不够好。获得医疗保健许多未确诊的活动性结核病患者去急诊室，而不是去全科医生那里。有些人几个月来一直不舒服。当最近搬到这个国家的人确实感到不适时，他们往往很难获得医疗服务。这可能导致诊断延误，导致疾病传播更广，费用更高，病情更严重，甚至死亡。方法本研究的参与者将从结核病诊所招募。这项研究将由一名在当地社区和结核病患者中具有丰富工作经验的医生进行。将要求患者提供书面知情同意书，并通过问卷调查和访谈收集信息。患者将被要求不间断地讲述他们从迁移到诊断的故事。为了确保结核病筛查和医疗服务的具体问题都包括在内，数量有限的更直接的半结构化的访谈问题将被用来“填补空白”的病人的narration. OUTCOMESSisproject将提供详细的洞察到结核病筛查和医疗服务提供移民的现有系统的局限性。成果将包括关于如何更有效和更容易获得这些服务的具体和详细的政策建议。研究结果将突出重点战略领域，应针对减少结核病在英国的疾病负担。研究结果还将适用于其他环境中的移民群体（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主要城市中心的结核病筛查。

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.