Table 2—

Process of screening of new entrants

Norway 1Norway 2Norway 3UK 1UK 2NetherlandsSwitzerland
AvailabilityMonday–Friday 08:00–15:30 hMonday–Friday 08:00–15:30 hMonday and Thursday 08:00–10:00Thursday 09:00–13:00Three mornings and one evening per monthFour days per week 08:30–15:00 hMonday–Friday 09:00–17:00 h
Open access clinic Tuesday 09.00–13.30
Source of referralPolice, camp staff on arrivalPolice and centre for asylum seekersHospital chest clinic1. Port of Arrival scheme, Heathrow Airport: referral to local CCDC to local hospital1. Port of Arrival scheme, Heathrow Airport: referral to local CCDC to local hospitalImmigration officeBorder control (Swiss Federal Office for refugees)
GP2. Registration with family doctor (GP)2. Homeless and Refugee team
3. Family doctors (GPs)
InvitationCompulsoryLetter in own language with appointmentLetter1. Letter from local hospital with own language contact1. Letter in own language from local hospitalCompulsoryCompulsory
Information given on arrivalVisit2. GP referral2. Direct referral from Homeless and Refugee team
TimingOn entryOn entry (within some weeks)When referral received (usually 0–4 months)When referral received (usually 0–3 months)1–3 months from entryWithin 2 weeksOn entry (1–2 days)
Symptoms screeningAll asked about symptomsIf abnormal radiographNoYesNo, only if abnormal radiograph or positive TSTYes, if abnormal radiograph
Tuberculin skin testingAll >6 monthsAll >6 monthsAll >6 monthsAll <35 yrsAll <25 yrsAll <26 yrs if no BCG scarAll
BCG scar noted and positivity adjusted accordinglyBCG scar noted and positivity adjusted accordinglyBCG scar noted and positivity adjusted accordinglyBCG scar noted and positivity adjusted accordinglyBCG scar noted and positivity adjusted accordinglyRepeat at 2 months if negativeBCG scar noted and positivity adjusted accordingly
Repeat at 6 weeks if negativeRepeat at 6 weeks if negativeRepeat at 6–8 weeks if negative
CXRAge >15 yrsAge >15 yrsAge >15 yrs1. At Port of Entry for symptoms1. At Port of Entry for symptoms1. Age <26 yrs and BCG scar1. If PPD+
2. If PPD+2. If PPD+2. Age >25 yrs2. Age >15 yrs
3. If symptoms and aged >35 yrs3. Age >25 yrs3. PPD+
4. If from high-incidence area and aged >35 yrs4. Any age if symptoms present
Sputum examinationIf irregularities found on radiographIf irregularities found on radiographNoIf sputum producedIf sputum producedAt MHS if abnormal radiographAt local hospital if abnormal radiograph
Blood testsDone at the local hospital when needed.OccasionallyNoIf PPD+ or CXR+If symptoms, abnormal CXR, or prior to chemoprophylaxisBasic laboratory at MHSAt local hospital if needed
Inflammatory markers
Offer of HIV and hepatitis screening
Outcomes
 1. TB treatedYesYesYesYesYesYesYes
 2. Preventive treatmentNot until later at campSometimesYesYes, if aged <35 yrsYes, if aged <16 yrs. Also considered for those 16–25 yrsYes (or radiographic follow-up)Yes, if indicated
 3. BCG vaccinationYesYesYesYes, PPD-Yes, aged <30 yrsYes, if <12 yrs of age and twice a negative TSTYes for children aged <1 yr
Outcomes recorded and accessible for auditNANAYesYesNAYesYes
Audit against local policyNoNoNoAnnualAudited at 1 and 4 yrs from start of programmeAnnualIntermittent
  • CCDC: Consultant in Communicable Disease Control; GP: general practitioner; TST: tuberculin skin test; BCG: bacillus Calmette–Guérin; PPD: purified protein derivative; MHS: Municipal Health Service; CXR: chest radiograph.