Tuberculosis transmission and community outreach screening in an informal urban settlement in a low-incidence European setting
10 affiliations
- 1Sant Roc Primary Care Center, Catalan Health Institute
- 2Research Support Unit Metropolitana Nord, Primary Care Research Institut Jordi Gol (IDIAPJGol)
- 3Departament of Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona
- 4Epidemiological Surveillance Service of Barcelonès Nord and Maresme. Secretaria de Salut Pública. Departament de Salut. Generalitat de Catalunya.
- 5Department of Infectious Diseases, Public Health and Community Team (eSPiC), Drassanes-Vall d’Hebron International Health Unit (USIDVH), Vall d’Hebron University Hospital
- 6International Health Unit of North Metropolitan Barcelona, Territorial Directorate for Infectious Diseases, Catalan Institute for Health
- 7Fundació Lluita Contra les Infeccions
- 8Germans Trias i Pujol Hospital and Research Institute (HUGTIP-IGTP)
- 9Microbiology Department, North Metropolitan Clinical Laboratory, Germans Trias i Pujol University Hospital
- 10Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias
Abstract
Background: Tuberculosis (TB) in low-incidence European settings disproportionately affects structurally vulnerable populations, including individuals living in informal housing. In late 2023, a TB cluster was identified among residents of an occupied building in Badalona, Spain. We report the implementation and outcomes of a community-based active TB screening intervention conducted in response.
Methods: We conducted a descriptive field investigation between October 2024 and February 2025 in an occupied former school that served as a residence and social hub for approximately 150 individuals (residents and non-resident community members). Three on-site interventions combined health education, symptom-based screening, and clinical assessment. Individuals with TB-compatible symptoms were referred for chest radiography and microbiological testing (smear microscopy, culture, and Xpert MTB/RIF Ultra) according to national protocols. WHO-recommended screening cascade indicators were calculated. Additional TB cases epidemiologically linked to the settlement were identified through surveillance data.
Findings: Eighty-one individuals were screened (54% of approximately 150 individuals connected to the settlement). Twelve presumptive TB cases were identified; all completed diagnostic evaluation. Three new TB cases were diagnosed through screening (number needed to screen = 27; number needed to test = 4). Two started treatment, and both completed it and were cured; the third never started treatment and was lost to follow-up. Overall, 11 TB cases were epidemiologically linked to the settlement (10 bacteriologically confirmed and one clinically diagnosed). The intervention also facilitated linkage to primary healthcare services. Operational challenges included high mobility, incomplete population enumeration, limited transport support, and institutional mistrust.
Interpretation: Active TB transmission can persist in informal urban settlements in low-incidence settings. Community-based outreach screening is feasible but operationally fragile and dependent on timely identification, institutional coordination, and social support to ensure adequate coverage and continuity of care.
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BibTeX
@article{flamarichgol2026tuberculosis,
title = {{Tuberculosis transmission and community outreach screening in an informal urban settlement in a low-incidence European setting}},
author = {Clara Flamarich-Gol and Mar Bosch-Arís and Gloria Blázquez and Alicia Garcia-Circuns and Baye Elimane Thiaw and Hakima Ouaarab Essadek and Sílvia Roure and Zoran Stojanovic and Salomé Bellido-Calduch and Macarena Lovera and Alba García-Delgado and Antonia Segura and Anna Carreres-Molas and Ignasi Guasch-Arriaga and Adrià Antuori and Alba Llop and Pablo Pillado and Yolanda Romero and Olga Antolín and Jordi Gómez i Prat and Ignasi Parrón and Elsa Plasencia and Cristina Vilaplana},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1907926},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1907926/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Tuberculosis transmission and community outreach screening in an informal urban settlement in a low-incidence European setting
AU - Clara Flamarich-Gol
AU - Mar Bosch-Arís
AU - Gloria Blázquez
AU - Alicia Garcia-Circuns
AU - Baye Elimane Thiaw
AU - Hakima Ouaarab Essadek
AU - Sílvia Roure
AU - Zoran Stojanovic
AU - Salomé Bellido-Calduch
AU - Macarena Lovera
AU - Alba García-Delgado
AU - Antonia Segura
AU - Anna Carreres-Molas
AU - Ignasi Guasch-Arriaga
AU - Adrià Antuori
AU - Alba Llop
AU - Pablo Pillado
AU - Yolanda Romero
AU - Olga Antolín
AU - Jordi Gómez i Prat
AU - Ignasi Parrón
AU - Elsa Plasencia
AU - Cristina Vilaplana
PY - 2026
DA - 2026/10/19
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1907926
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1907926/full
AB - Background: Tuberculosis (TB) in low-incidence European settings disproportionately affects structurally vulnerable populations, including individuals living in informal housing. In late 2023, a TB cluster was identified among residents of an occupied building in Badalona, Spain. We report the implementation and outcomes of a community-based active TB screening intervention conducted in response. Methods: We conducted a descriptive field investigation between October 2024 and February 2025 in an occupied former school that served as a residence and social hub for approximately 150 individuals (residents and non-resident community members). Three on-site interventions combined health education, symptom-based screening, and clinical assessment. Individuals with TB-compatible symptoms were referred for chest radiography and microbiological testing (smear microscopy, culture, and Xpert MTB/RIF Ultra) according to national protocols. WHO-recommended screening cascade indicators were calculated. Additional TB cases epidemiologically linked to the settlement were identified through surveillance data. Findings: Eighty-one individuals were screened (54% of approximately 150 individuals connected to the settlement). Twelve presumptive TB cases were identified; all completed diagnostic evaluation. Three new TB cases were diagnosed through screening (number needed to screen = 27; number needed to test = 4). Two started treatment, and both completed it and were cured; the third never started treatment and was lost to follow-up. Overall, 11 TB cases were epidemiologically linked to the settlement (10 bacteriologically confirmed and one clinically diagnosed). The intervention also facilitated linkage to primary healthcare services. Operational challenges included high mobility, incomplete population enumeration, limited transport support, and institutional mistrust. Interpretation: Active TB transmission can persist in informal urban settlements in low-incidence settings. Community-based outreach screening is feasible but operationally fragile and dependent on timely identification, institutional coordination, and social support to ensure adequate coverage and continuity of care.
SN - 2296-2565
ER -