Drivers determining active TB screening yield in different European screening programmes: a comparative analysis.

<b>Introduction:</b> The WHO End-TB Strategy emphasises early diagnosis and screening of tuberculosis (TB) in high-risk groups, including migrants. We analysed key drivers behind differences in TB yield in four large migrant TB screening programmes to inform TB control planning. <b>Methods:</b> We pooled routinely collected individual TB screening episode data from Italy, the Netherlands, Sweden, and the UK under the EU Commission E-DETECT. TB grant. We analysed predictors and interactions for TB case yield using multivariable logistic regression models. <b>Results:</b> We collected data gathered between 2005-2018 on 2,302,260 screening episodes among 2,107,016 migrants to four countries; the programmes identified 1,658 TB cases (yield 72.0 per 100,000; 95% confidence interval, CI 68.6-75.6). In the logistic regression analysis, we found significant associations between TB screening yield and increasing age, migrant typology, higher TB incidence in the country of origin (CoO), TB case contact, period of screening, and additional programmatic effects. We demonstrated interactions between migrant typology and age, as well as CoO. For asylum seekers, the elevated TB risk (aOR 4.64, CI 3.17-6.8) remained similar above CoO incidence thresholds of 50 per 100,000. <b>Conclusions:</b> Contrary to previous studies we demonstrated that the risk of TB detection among asylum seekers is not significantly influenced by incidence in their CoO if it is above 50 per 100,000, possibly reflecting the higher transmission and reactivation risk of migration routes. This key finding may help better determining eligible populations for TB screening programmes.