Background Migration is a major global driver of population change. Certain migrants may be at increased risk of infectious diseases, including tuberculosis (TB), HIV, hepatitis B and hepatitis C, and have poorer outcomes. Early diagnosis and management of these infections can reduce morbidity, mortality and onward transmission and is supported by national guidelines. To date, screening initiatives have been sporadic and focused on individual diseases; systematic routine testing of migrant groups for multiple infections is rarely undertaken and its impact is unknown. We describe the protocol for the evaluation of acceptability, effectiveness and cost-effectiveness of an integrated approach to screening migrants for a range of infectious diseases in primary care.
Methods and analysis We will conduct a mixed-methods study which includes an observational cohort with interrupted time-series analysis before and after the introduction of routine screening of migrants for infectious diseases (latent TB, HIV, hepatitis B and hepatitis C) when first registering with primary care within Leicester, UK. We will assess trends in the monthly number and rate of testing and diagnosis for latent TB, HIV, hepatitis B and hepatitis C to determine the effect of the policy change using segmented regression analyses at monthly time-points. Concurrently, we will undertake an integrated qualitative sub-study to understand the views of migrants and healthcare professionals to the new testing policy in primary care. Finally, we will evaluate the cost-effectiveness of combined infection testing for migrants in primary care.
Ethics and dissemination The study has received HRA and NHS approvals for both the interrupted time-series analysis (16/SC/0127) and the qualitative sub-study (16/EM/0159). For the interrupted time-series analysis we will only use fully anonymised data. For the qualitative sub-study, we will gain written, informed, consent. Dissemination of the results will be through local and national meetings/conferences as well as publications in peer-reviewed journals.
- latent tuberculosis
- blood-borne virus
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Contributors MPareek, HCE, DB, PG, IA and CG conceived of the study idea. MPareek will undertake data analysis under the guidance of EK and FZ. MPareek, HCE, FW and KSE are involved in recruitment and analysis of the qualitative sub-study. MPareek, RB, TDH and CG will undertake the health-economic analysis. MPareek, HP, PH, MPatel, IB, RK, IS and AF set-up and run the migrant testing service.
Funding MPareek is supported by the National Institute for Health Research (NIHR Post-Doctoral Fellowship, Dr Manish Pareek, PDF-2015-08-102). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. Gilead Sciences provided an unrestricted grant to fund the cost of the blood-borne virus tests but had no other involvement in the study.
Competing interests MP and PH report an institutional grant (unrestricted) for project related to blood-borne virus testing from Gilead Sciences outside the submitted work. All other authors report no conflicts of interest.
Ethics approval The study protocol has received HRA and NHS approvals for both the interrupted time-series analysis (16/SC/0127) and the qualitative sub-study (16/EM/0159). For the interrupted time-series analysis we will be using fully anonymised data. For the qualitative sub-study we will gain written, informed, consent before any study procedures are conducted. Dissemination of the results will be through local and national meetings/conferences as well as publications in peer-reviewed journals.
Provenance and peer review Not commissioned; peer reviewed for ethical and funding approval prior to submission.
Patient consent for publication Not required.
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