Tuberculosis screening of new entrants; how can it be made more effective?

Background: The importance of extending TB screening to all new entrants has been shown by the occurrence of cases of active TB and high rates of those needing prophylaxis or BCG protection. TB is particularly likely to be prevalent in populations with large numbers of refugees, but high rates in immigrants have been reported consistently both in this country and elsewhere in Europe.
Method: This paper examines possible reasons for a low uptake of screening by immigrants in the United Kingdom and describes initiatives, some of which have already been launched in East London, by which access to screening could be increased.
Results: Screening at the new patient check-up by general practitioners has been shown to be practicable and effective in an East London pilot. This screening method could be expanded throughout East London and is applicable to other areas. Other ways of improving access to screening through other agencies have also been found to be acceptable.
Conclusion: No one screening system is likely to be effective and pilots of methods of extending the access to new entrants need to be carried out and evaluated urgently.