Clinical Scorecard: Undetected Transmission: The Impact of Tuberculosis on Migrant and Asylum-Seeking Youth in Scotland and Associated Delays in Care Pathways

At a Glance

Key Highlights

• Of 131 individuals assessed, 117 (89.3%) underwent TB screening.

• LTBI was identified in 13 screened participants (11.1%), and active pulmonary or disseminated TB was identified in 2 (1.7%).

• Overall, 15 of 117 screened participants (12.8%) had latent or active TB.

• Treatment had been initiated in 14 of 15 identified cases (93.3%) at the time of data collection; treatment was subsequently initiated for the remaining case.

• Median time from screening to treatment initiation was 35 days, although 3 of 13 LTBI cases experienced intervals exceeding 90 days.

• Three of the 15 TB-positive participants originated from medium- or low-incidence countries.

Guideline-Based Recommendations

This observational study did not establish new clinical guidelines. It discussed existing screening guidance and proposed areas for further research and service development.

Diagnosis

• Scottish guidance recommends targeted screening for individuals originating from countries with a TB incidence of at least 150 cases per 100,000 population.

• UK pediatric guidance recommends TB screening for asymptomatic refugee and asylum-seeking children and young people.

• That guidance also recommends proactive referral when children from lower-incidence countries may have experienced migration-related exposure, including overcrowding or residence in refugee camps.

• Country of origin alone may provide only a partial indication of individual TB-exposure risk.

Management

• Treatment was initiated in 93.3% of the latent and active TB cases identified by the time of data collection.

• The findings indicate opportunities to optimize referral and postdiagnosis pathways and reduce variation in treatment-initiation intervals.

• The authors proposed culturally appropriate communication, interpreter use, and reminder systems as possible ways to improve engagement and reduce avoidable delays.

• The study did not compare treatment regimens or establish new therapeutic recommendations.

Monitoring & Follow-up

• Future service evaluations could examine screening uptake, identified TB burden, treatment initiation, and time to treatment.

• Integrating TB screening into broader migrant and asylum health assessments may enhance continuity of care and reduce fragmentation.

• Repeated or opportunistic screening may warrant consideration for individuals with continuing risk factors or barriers to initial engagement.

• Larger multisite studies are needed to evaluate screening strategies and care pathways in more diverse populations and settings.

Risks

• TB risk may be influenced by premigration exposure, migration journeys, transit conditions, displacement, overcrowding, refugee-camp residence, and barriers to healthcare after arrival.

• Fourteen individuals declined screening or were not screened for operational reasons, leaving their TB status unknown and potentially causing prevalence to be underestimated.

• The authors identified nonattendance, additional investigations, and continuity-of-care challenges as likely contributors to some delays; other patient- and system-level factors require further study.

• Three of the 15 TB-positive cases would not have been identified if screening had been restricted to participants from WHO high-incidence countries.

Patient & Prescribing Data

The cohort included 131 migrant and asylum-seeking children and adolescents, of whom 117 underwent screening. Among those screened, 13 had LTBI and 2 had active pulmonary or disseminated TB.

Treatment had been initiated in 14 of 15 cases at the time of data collection. Median time from screening to treatment initiation was 35 days. Five of 13 LTBI cases began treatment within 28 days, whereas 3 began treatment after more than 90 days. The study did not report specific treatment regimens or compare prescribing strategies.

Clinical Best Practices

• Apply targeted TB screening consistently within eligible migrant and asylum-seeking populations.

• Consider migration-related exposures and experiences alongside country-of-origin incidence when assessing TB risk.

• Maintain follow-up after positive screening to support further investigation and timely treatment initiation.

• Consider culturally appropriate communication, interpreter support, and reminder systems when addressing barriers to engagement.

• Interpret the findings as hypothesis-generating because they came from a small, single-service observational study with only 15 TB-positive cases.

Related Resources & Content

1. Silent Spread: Tuberculosis Burden and Care Pathway Delays Among Migrant and Asylum-Seeking Children and Adolescents in Scotland — Lucas S, Montgomery L, Sculthorpe N, Mackay W, McKay L. International Journal of Infectious Diseases. 2026;171:108930. doi:10.1016/j.ijid.2026.108930.

2. Global Tuberculosis Report 2024 — World Health Organization. Geneva: WHO; 2024.

3. Roadmap Towards Ending TB in Children and Adolescents — World Health Organization. 3rd ed. Geneva: WHO; 2023.

4. Tuberculosis Annual Report 2023 — Public Health Scotland. Edinburgh: Public Health Scotland; 2024.

5. Tuberculosis (NG33) — National Institute for Health and Care Excellence. London: NICE; 2023.

6. Refugee and Asylum-Seeking Children and Young People: Guidance for Paediatricians — Royal College of Paediatrics and Child Health. London: RCPCH; 2022.