Silent spread: tuberculosis burden and care pathway delays among migrant and asylum-seeking children and adolescents in Scotland

Objectives
To quantify tuberculosis (TB) burden and evaluate screening outcomes and care pathway performance among migrant and asylum seeking children and adolescents in Scotland, where implementation of targeted screening remains variable. The study also explored time from screening to treatment initiation.

Methods
A retrospective observational study used routinely collected clinical data from a UK health service. Children and adolescents eligible for TB screening during the study period were included. Primary outcomes were prevalence of latent TB infection (LTBI) and active TB. Secondary outcomes included screening uptake, treatment initiation, and time to treatment initiation.

Results
Of 131 individuals assessed, 117 (89.3%) underwent TB screening. LTBI prevalence was 11.1% (13/117), and 1.7% (2/117) had active TB, giving an overall TB positivity rate of 12.8% (15/117). Treatment was initiated in 93.3% (14/15) of identified cases. Median time from screening to treatment initiation was 35 days. Treatment was initiated within 28 days of screening for 38.5% of participants, while 23.1% experienced delays exceeding 90 days. Cases were identified among participants from both higher and lower TB incidence countries.

Conclusions
A substantial burden of latent and active tuberculosis was identified among migrant and asylum seeking children and adolescents attending a targeted screening service within a low incidence setting. Targeted screening was feasible, achieved high uptake, and identified clinically important cases. Treatment initiation rates were high and care was generally delivered within a relatively short timeframe following diagnosis, although variation in treatment initiation intervals was observed. These findings support targeted screening approaches and highlight the need for further research to optimise care pathways and better understand how migration related exposures and experiences influence tuberculosis risk within migrant and asylum seeking populations.