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Community-based testing of migrants for infectious diseases (COMBAT-ID): impact, acceptability and cost-effectiveness of identifying infectious diseases among migrants in primary care: protocol for an interrupted time-series, qualitative and health economic analysis
  1. Manish Pareek1,2,
  2. Helen C Eborall3,
  3. Fatimah Wobi1,3,
  4. Kate S Ellis2,
  5. Evangelos Kontopantelis4,5,
  6. Fang Zhang6,
  7. Rebecca Baggaley7,8,
  8. T Deirdre Hollingsworth9,
  9. Darrin Baines10,
  10. Hemu Patel11,
  11. Pranabashis Haldar1,12,
  12. Mayur Patel13,
  13. Iain Stephenson2,
  14. Ivan Browne14,
  15. Paramjit Gill15,
  16. Rajesh Kapur13,
  17. Azhar Farooqi13,
  18. Ibrahim Abubakar16,
  19. Chris Griffiths17
  1. 1 Department of Respiratory Sciences, University of Leicester, Leicester, UK
  2. 2 Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
  3. 3 Department of Health Sciences, University of Leicester, Leicester, UK
  4. 4 Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
  5. 5 Centre for Primary Care, NIHR School for Primary Care Research, Manchester, UK
  6. 6 Department of Population Medicine, Harvard Pilgrim Health Care, Wellesley, Massachusetts, USA
  7. 7 Department of Infectious Disease Epidemiology, Imperial College London, London, UK
  8. 8 Department of Global Health and Development, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
  9. 9 Big Data Institute, University of Oxford, Oxford, UK
  10. 10 Department of Accounting , Finance & Economics, Bournemouth University, Poole, UK
  11. 11 Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK
  12. 12 Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
  13. 13 NHS Leicester City Clinical Commissioning Group, NHS Leicester City Clinical Commissioning Group, Leicester, UK
  14. 14 Department of Public Health, Leicester City Council, Leicester, UK
  15. 15 Academic Unit of Primary Care, University of Warwick, Warwick, UK
  16. 16 Institute of Global Health, University College London, London, UK
  17. 17 Barts Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, London, UK
  1. Correspondence to Dr Manish Pareek; mp426{at}le.ac.uk

Abstract

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.

  • migrant
  • latent tuberculosis
  • blood-borne virus
  • screening

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • 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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