Infection screening in newly arrived Afghan sanctuary seekers – a family-centred approach

BACKGROUND: The fall of Kabul to Taliban rule in 2021 placed Afghan citizens working as Locally Employed Staff at risk of threat to life. Approximately 15,000 Afghan citizens were evacuated to the UK under the Afghan Relocation and Assistance Policy (ARAP). Given the urgency, many did not undergo pre-entry screening for infections. The Respond Family Infection Clinic was developed to support the needs of this population. METHOD: All sanctuary-seekers who arrived under the ARAP and attended the Respond Family Infection Clinic for screening between November 2021 to March 2023 were included. Family units were defined as having at least one family member who arrived via ARAP. Individual clinical data was extracted from electronic healthcare records and manually grouped into family units. Data was analysed using Microsoft Excel (16.47). RESULTS: 587 Afghan sanctuary-seekers within 94 family units were screened in the study period. 216 infections were identified across the cohort. 17 family units (18.1%) had at least one infection detected within the unit and 55 family units (58.5%) had multiple infections detected (multiple of the same infection and/or different infections). Giardia lamblia was the commonest infection identified (57.9% of individuals) in our study population. There was significant prevalence of tuberculosis infection amongst adult individuals (19.1%) and family units (35.1%), as well as Hepatitis B infection (2.2% adults and 4.3% family units). All individuals with positive results were offered treatment. CONCLUSION: We describe a family-centred infection screening and treatment service for sanctuary-seekers in North Central London. Our results show significant prevalence of infection in both individuals and family units with potential consequences for personal and public health. Given the prevalence of infections affecting multiple members of family units, provision of care to families in a single appointment with simultaneous management of household contacts reduces the number of appointments required and mitigates the risk of reinfection.