Rates of migration to Europe, and within Europe, have increased in recent years, with
considerable implications for health systems. Migrants in Europe face a disproportionate
burden of tuberculosis, HIV, and hepatitis B and C, yet experience a large number
of barriers to accessing statutory health care on arrival. A better understanding
of how to deliver effective and cost-effective screening, vaccination, and health
services to this group is now crucial. We did a systematic review to document and
assess the effectiveness and cost-effectiveness of approaches used for infectious
diseases screening, and to explore facilitators and barriers experienced by migrants
to accessing screening programmes. Following PRISMA guidelines, we searched Embase,
PubMed, PsychINFO, the Cochrane Library, and Web of Science (1989 to July 1, 2015,
updated on Jan 1, 2018), with no language restrictions, and systematically approached
experts across the European Union (EU) for grey literature. Inclusion criteria were
primary research studies assessing screening interventions for any infectious disease
in the migrant (foreign-born) population residing in EU or European Economic Area
(EEA) countries. Primary outcomes were the following effectiveness indicators: uptake
of screening, coverage, infections detected, and treatment outcomes. Of 4112 unique
records, 47 studies met our inclusion criteria, from ten European countries (Belgium,
Denmark, France, Italy, the Netherlands, Norway, Spain, Sweden, Switzerland, and the
UK) encompassing 248 402 migrants. We found that most European countries screening
migrants focus on single diseases only-predominantly active or latent tuberculosis
infection-and specifically target asylum seekers and refugees, with 22 studies reporting
on other infections (including HIV and hepatitis B and C). An infection was detected
in 3·74% (range 0·00-95·16) of migrants. Latent tuberculosis had the highest prevalence
across all infections (median 15·02% [0·35-31·81]). Uptake of screening by migrants
was high (median 79·50% [18·62-100·00]), particularly in primary health-care settings
(uptake 96·77% [76·00-100·00]). However, in 24·62% (0·12-78·99) of migrants screening
was not completed and a final diagnosis was not made. Pooled data highlight high treatment
completion in migrants (83·79%, range 0·00-100·00), yet data were highly heterogeneous
for this outcome, masking important disparities between studies and infections, with
only 54·45% (35·71-72·27) of migrants with latent tuberculosis ultimately completing
treatment after screening. Coverage of the migrant population in Europe is low (39·29%
[14·53-92·50]). Data on cost-effectiveness were scarce, but suggest moderate to high
cost-effectiveness of migrant screening programmes depending on migrant group and
disease targeted. European countries have adopted a variety of approaches to screening
migrants for infections; however, these are limited in scope to single diseases and
a narrow subset of migrants, with low coverage. More emphasis must be placed on developing
innovative and sustainable strategies to facilitate screening and treatment completion
and improve health outcomes, encompassing multiple key infections with consideration
given to a wider group of high-risk migrants. Policy makers and researchers involved
with global migration need to ensure a longer-term view on improving health outcomes
in migrant populations as they integrate into health systems in host countries.