Tongue swabs accepted for TB screening among migrants in Northern Italy

Human migration driven by economic hardship, conflict, and climate change makes tuberculosis (TB) control more complex around the world. Traditional screening relies on sputum samples, which can be hard to collect in many settings because they require privacy, time, and sometimes repeated attempts. Researchers led by Daniela María Cirillo explored whether a simpler option—tongue swabs taken through supervised self-swabbing (SSS)—would be acceptable to migrants arriving in Northern Italy. Tongue swabs are designed to be easier than sputum collection and have shown acceptable accuracy in other studies, which makes them a promising alternative for active TB screening. The research team focused on the lived experiences and views of migrants to understand if SSS could realistically be used in reception centers and clinics. By listening directly to people who had recently traveled the Central Mediterranean route, the researchers wanted to learn whether SSS would be seen as practical, respectful of privacy, and likely to increase participation in TB screening programs.

Between November 2023 and June 2024 the team conducted 24 in-depth interviews (IDIs) with migrant men and women who had arrived via the Central Mediterranean route. Interviews were carried out with the help of a cultural mediator, and the researchers used a rapid qualitative analysis approach to summarize findings. The Capability, Opportunity, Motivation-Behavior (COM-B) model was used to guide a systematic look at potential barriers and facilitators to SSS. Most participants said they preferred SSS over producing sputum, describing swabbing as relatively easy, private, and more acceptable than sputum collection, which many find unpleasant. Discomfort during swabbing was reported only rarely. A small number of people preferred sputum and mentioned oral hygiene-related complications as a reason. Participants also pointed out practical obstacles that could limit uptake: language barriers, lack of trust in the health system, and limited health literacy about infectious diseases including TB. Several interviewees said that their willingness to take part in screening could be influenced by a desire to comply with immigration rules.

The study suggests that supervised self-swabbing using tongue swabs is a promising and acceptable approach for TB screening among migrants in Northern Italy. Because SSS was generally easier and more private than sputum collection, it could reduce practical challenges that limit screening in reception settings. However, acceptability alone may not be enough to ensure high participation. The researchers highlight the need to build trust and improve understanding about TB among migrant communities. To make SSS work in real-world programs, future efforts should create culturally and linguistically tailored educational materials that answer specific concerns, explain how the test works, and clarify why screening matters. Addressing language gaps, health literacy, and trust in services will be important to turn acceptability into actual uptake, so that SSS can meaningfully strengthen TB mitigation strategies for people arriving through migration routes.