Feasibility and Operational Lessons from Active Tuberculosis Disease Screening Among Ukrainian Refugees in Barcelona: A Pilot Study

Background: Following the 2022 Russian invasion of Ukraine, more than 18 000 Ukrainian refugees arrived in Barcelona, Spain. Given Ukraine’s high tuberculosis (TB) incidence and multidrug-resistant TB burden, the SYS-TB project piloted community-based active TB disease screening to assess the feasibility of implementing the World Health Organization (WHO) recommendations for vulnerable populations in a low-incidence European setting. Methods: Two TB screening events were conducted between July and October 2022 in collaboration with the Public Health Agency of Barcelona and the Ukrainian association Djerelo . Ukrainian refugees aged ≥ 16 years were invited to participate. The screening included an information session on TB symptoms and healthcare access, followed by a symptom questionnaire and referral for chest X-ray (CXR) for those reporting TB-related symptoms. Attendance, participation, and operational barriers were recorded and analysed descriptively. Results: Seventy-six individuals attended the two events, and 35 (46%) completed TB symptom screening. Of these, 28 (80%) were female, with a median age of 45 years. Most participants had arrived in Barcelona within the previous six months. Ten (29%) individuals were referred for CXR, and none were diagnosed with active TB disease. Main challenges included communication barriers, logistical constraints, and mismatched participant expectations. Introducing pre-registration and streamlining information sessions improved efficiency and participant flow during the second event. Conclusion: Community-based TB screening among Ukrainian refugees in Barcelona was operationally feasible but yielded few cases. Collaboration with trusted community organisations, adequate preparation, and culturally tailored communication were essential for engagement. Lessons from this pilot can inform future targeted screening initiatives for displaced populations in low-incidence settings. Trial registration: ClinicalTrials.gov Identifier: NCT06706596, retrospectively registered on November 29, 2024