A Systematic Review on Pulmonary TB Burden and Associated Factors Among Immigrants in the UK

Abstract

Background

The rapid growth of international human migration has positioned the UK in the top five countries in the world with 9.4 million immigrants in 2022. These immigrants originate from low- and middle-income countries and remain particularly at risk of developing TB. In the UK, the number of TB cases has been increasing, and the influx of immigrants could be a contributing factor.

Objective

This review aims to map the burden of pulmonary TB among immigrants in the UK and investigate associated factors. It also reviews the TB management approaches among immigrants in the UK.

Design

The study utilized PRISMA guidelines to search electronic databases (PubMed and EMBASE) for articles published from 2000 to 2022 on TB prevalence and factors in immigrants and explored government websites for TB management strategies.

Results

Nineteen out of 530 initially identified articles were included. The included studies reported a prevalence rate of TB among immigrants ranging from 0.04 to 52.1%, showing a decrease in the burden over time. Additionally, a higher number of TB cases were observed among immigrants from the Asian region, particularly immigrants from South Asia, followed by those from sub-Saharan Africa. Stigma, misconception about the disease, language barrier, lack of confidentiality, and unfriendly healthcare system for immigrants were the main drivers of the TB burden among immigrants. The TB management approaches in the UK include pre-entry screening for active TB, LTBI testing for a specific population group, and antibacterial therapy for 3–6 months for TB patients.

Conclusion

The UK’s control and prevention efforts in reducing tuberculosis prevalence among immigrants show optimism, but challenges persist. Key improvements include healthcare delivery, TB improvement programs, and policies addressing stigma and patient confidentiality.

Keywords:

• TB
• UK
• immigrants
• pulmonary infection
• tuberculosis

Abbreviations

BCG, Bacillus Calmette-Guérin vaccine; GP, General Practitioner; IGRA, Interferon-gamma Release Assay; IOM, International Organization for Migration; JBI, Joanna Briggs Institute; LTBI, Latent Tuberculosis Infection; MDRTB, Multi-Drug-resistant TB; NHS`, National Health Service; NICE, National Institute for Health and Care Excellence; PCO, Primary care organization; PPD, Purified protein derivative; PRISMA, Preferred Reporting Items for Systematic Review and Meta-Analysis Statement; SSA, sub-Saharan Africa; TB, Tuberculosis; TST, Tuberculin Skin Test.

Data Sharing Statement

The data that support the findings of this study are available from research ethics committee of Maastricht University with the registered code of i6245882, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are, however, available from the authors and the mentioned committee upon reasonable request and with permission of Uzair Ahmad Saleem and Hedaytullah Ehsan.

Ethical Approval and Guidelines

Prior to the start of this study, the research protocol was submitted for review to research ethics board of Maastricht University. This committee usually consists of qualified experts who transparently provide comment, guidance, and approval of research. This study was supervised and confirmed based on the ethical principles (10 specific principles of Helsinki; scientific requirements and research protocols, informed consent, privacy and confidentiality, research registration and publications, and so on) of this committee.

The supervision and registration of this study within the research ethics committee of Maastricht University was done (code: i6245882) by Professor Dr. Elena Ambrosino. Therefore, we would like to thank our study advisor Dr. Elena Ambrosino for always being there and providing guidance throughout the study period. She allowed this study to be our own work but steered us in the right direction with her valuable feedbacks.

Consent for Publication

There are no limits or ethical concerns for publication because this is a systematic review and not original research. Additionally, the research committee of Maastricht University evaluated this manuscript and after evaluating and making changes, the committee approved its publishing. So, all of them gave their consent for publication.

Acknowledgment

First and foremost, I am thankful to Almighty ALLAH for giving us the strength, knowledge, ability and opportunity to undertake this study and complete it.

Secondly, we would like to thank my thesis advisor Dr. Elena Ambrosino for always being there and providing guidance throughout the study period. She allowed this study to be our own work but steered us in the right direction with her valuable feedbacks.

Disclosure

We have read and understood the journal policy on declaration of interests and declare that we have no competing interests.

Additional information

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.