What are the recommended screening protocols for tuberculosis (TB) in high-risk populations in primary care?

Recommended screening protocols for tuberculosis (TB) in high-risk populations within primary care settings include:

• Primary care services should actively support local and community-based organisations to ensure vulnerable migrants register with primary care and understand how to use NHS services, including emergency and primary care.

• All vulnerable migrants who have not previously been screened should be tested for latent TB infection, prioritising those born in countries with TB incidence greater than 150 per 100,000 per year, regardless of their arrival date in England.

• In areas with identified high TB incidence, especially major urban centres, active case-finding should be conducted using mobile chest X-ray screening in locations frequented by homeless people and those who misuse substances, such as hostels, day centres, and needle exchange venues.

• The frequency of screening at any location should be based on population turnover, and where local demand is insufficient, mobile X-ray capacity should be commissioned from other areas.

• Multidisciplinary TB teams should collaborate closely with mobile X-ray teams and frontline staff in hostels and day centres to promote TB screening and ensure appropriate referrals and follow-up.

• Use of simple incentives (e.g., hot drinks and snacks) and peer educators is recommended to encourage attendance for TB testing in high-risk groups.

• People who are homeless or misuse substances should be offered additional health interventions during TB screening, such as blood-borne virus screening and dental or podiatry services.

• Healthcare professionals in prisons and immigration removal centres should screen all new arrivals for TB within 48 hours, including chest X-rays if not done in the previous 6 months.

• Contact tracing and active case-finding should be coordinated by multidisciplinary TB teams, focusing on social networks and settings where under-served high-risk groups congregate, using digital mobile X-ray and social network analysis where appropriate.

These protocols emphasise early identification of latent and active TB in high-risk groups through targeted testing, mobile radiography, multidisciplinary collaboration, and community engagement within primary care and associated services.

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