Screening for tuberculosis among newly arrived migrants in France. Results from a practice study

Abstract Background Screening of active and latent tuberculosis among migrants is a public health concern but physicians’ practices are poorly known. The study aimed to evaluate physicians’ practices in France. Methods A national survey of physicians’ practices about infectious diseases prevention among migrants was conducted in 2017-2018 and broadcasted by several scientific societies. Results In total, 367 physicians answered; 53.1% were primary care physicians, 34.3% “TB involved physicians”, and 85.5% were involved daily with migrants. Screening by chest X ray is recommended by 84.8%, 71.9% and 38.4% of participants for migrants from high- (>100 cases/100,000 p.a.), medium- (> 50/100,000), and low-incidence countries respectively. One physician in two declares considering migration conditions in his/her decision of screening migrants from low incidence countries. Primary care physicians are less likely to offer screening (aOR= 0.21[0.09-0.48], p < 0.001). About screening prescription, only 55.6% consider it their responsibility. TB control centres are designated by 56.7% of respondents. Concerning screening for latent tuberculosis infection (LTBI), 61.8% and 34.0% offered screening for children under the age of 15 and for all migrants (adults and children) from high incidence countries respectively; physicians working in Paris and its region being less likely to offer it (aOR=0.45 [0.28-0.71], p = 0.001 and aOR=0.43 [0.27-0.69] p = 0.001 respectively). Among those screening children, 88.1% recommend treatment if facing a positive result, most often with a 3-month isoniazid rifampicin double therapy, and 11.4% offer follow up alone. Conclusions Physicians’ practices in France regarding screening of tuberculosis among migrants are heterogeneous. Which population should be targeted for LTBI screening remains unclear in the context of contradictory national and international recommendations. The results of our study raise the issue of knowledge, and adherence to these guidelines. Key messages Physicians’ practices in France concerning active and latent tuberculosis screening among newly arrived migrants are heterogeneous. Many physicians involved in migrants’ care ignore or do not adhere to current national guidelines, especially concerning LTBI screening among newly arrived migrants.