Systematic screening for active tuberculosis amongst refugees and asylum seekers in Western Europe: Is universal chest radiography justified? A literature review.

Introduction: Tuberculosis (TB) prevalence is considered high amongst refugees and asylum seekers (RAAS). Active TB screening using universal (indiscriminate) chest radiography (CXR) has been adopted in several European countries. Universal CXR screening raises concerns for radiation protection; no existing research reviews the literature from a radiography perspective. This review aims to identify and analyse relevant primary research to discuss the justification of universal CXR for RAAS in an active TB screening context.

Methods: The search strategy included the databases CINAHL, MEDLINE, EMBASE and ScienceDirect and used predefined Boolean search terms and inclusion/exclusion criteria. A critical appraisal evaluated the quality of papers included in the review, and a synthesis-analysis method was used to find common themes.

Results: Eight papers were included in the review. The thematic analysis identified three themes for discussion: the 2014/15 crisis, the complexity of defining TB risk amongst RAAS, and the value of CXR-led versus symptom-led screening for RAAS. Findings support continued systematic screening for TB amongst RAAS but with re-evaluation of CXR eligibility or the screening algorithm.

Conclusions: The heterogeneity of TB risk amongst RAAS indicates that CXR-led screening should be targeted at specific high-risk groups rather than universally applied.

Implications For Practice: Justification of CXR screening for RAAS is context-specific and should be informed by TB risk amongst the target population. The advantages of CXR-led screening over other screening algorithms (e.g. symptom-led) justify its use for TB screening in most settings. Considerations identified in this literature review could help inform the development of local protocols for justifying CXR for TB screening amongst RAAS.