P228 Uptake, effectiveness and acceptability of routine screening of pregnant migrants for latent tuberculosis infection in antenatal care: a feasibility study

<h3>Rationale</h3> Globally, tuberculosis (TB) is a leading cause of death in women of reproductive age. There is high risk of reactivation of latent tuberculosis infection (LTBI) in pregnancy. The uptake of routine screening of migrants for LTBI in the UK in primary care is low. Our study evaluates the uptake, effectiveness and acceptability of offering routine opt-out screening for LTBI in antenatal care (ANC). <h3>Methods</h3> Observational feasibility study with a nested qualitative component. Inclusion criteria were pregnant migrant women aged 16–35 years, attending antenatal clinics in an NHS Trust, from countries with a TB incidence of greater than 150/100,000 including sub-Saharan Africa, and who have been in the UK for less than 5 years. Participants were offered opt-out screening with an interferon gamma release assay (IGRA). Analysis estimated the proportion of eligible women who were offered LTBI screening, the rate of uptake of LTBI screening, and IGRA test positivity. Semi-structured interviews and focus groups conducted with migrant women and midwives evaluated acceptability, understanding and feasibility of LTBI screening. <h3>Results</h3> 750 participants were eligible for LTBI screening, of whom 302 (40.3%) were offered an IGRA test. Uptake was 100%. Forty of 302 women (13.3%) had a positive IGRA test (table 1). Qualitative research identified some awareness of TB but a lack of prior knowledge about LTBI in pregnant migrant women. The biggest barrier to screening uptake was in relation to language and access to interpreters. Midwives commented on the public health benefits of screening and noted that for many migrant women this may be the first regular contact with the NHS. Midwives acknowledged the importance of routine opt-out screening for LTBI in pregnancy as an important measure to reduce stigma and improve uptake. They report busyness of ANC clinics and low confidence due to lack of detailed knowledge about LTBI as some of the barriers to offer of screening. <h3>Conclusions</h3> Our study reported an uptake rate of 100% for routine opt-out LTBI screening in ANC but offer of screening was low. Routine opt-out LTBI screening in ANC is both feasible and acceptable to pregnant migrant women and midwives.