Latent tuberculosis screening and treatment among asylum seekers: a mixed-methods study (original) (raw)
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Pathogens
Background: Effective screening for tuberculosis infection (TBI) among asylum seekers (AS) is crucial for tuberculosis (TB) elimination in low incidence countries. Methods: We assessed the proportion of completion of the screening for TBI among asylum seekers with a centralized delivery method compared to the decentralized model previously adopted in the study area (historical control). In the historical model (January 2017 to May 2018) screening of AS was performed at the arrival offering TBI testing (TST followed by IGRA among those positive), radiological investigation, treatment initiation and hospital referral, if needed, at three sites: migrant health clinic, pneumology clinic and infectious diseases department for active disease (decentralized model). In the study model (June 2018, centralized) all steps of screening were performed at a single site, at a minimum of 6 months after arrival. Multivariable Poisson regression analysis, with robust variance, was used to assess vari...
Research Square (Research Square), 2020
Background: In the Netherlands, migrant populations with a high tuberculosis (TB) incidence are an important target group for TB prevention. However, there is a lack of insight in effective communityengaged strategies to reach and motivate these migrants to participate in latent TB infection (LTBI) screening and treatment programs. Methods: In cocreation with Eritrean key figures and TB staff, we designed and executed six strategies to reach and motivate Eritrean communities to participate in LTBI programs, in five regions in the Netherlands. We registered participation in LTBI education and screening, and LTBI treatment uptake and completion. We used semi-structured group and individual interviews with Eritrean participants, key figures, and TB staff to identify facilitators and barriers. Results: Uptake of LTBI education (13%-75%) and consequent screening (10%-124%) varied between strategies. LTBI screening uptake >100% resulted from educated participants motivating others to participate in screening. Two strategies, using face-to-face promotion and targeting smaller groups, were the most successful. The program resulted in high LTBI treatment initiation and completion (both 97%). Reported program barriers included: competing priorities in the target group, perceived good health, poor risk perception, and scepticism towards the program purpose. TB staff perceived the program as useful but demanding in terms of human resources. Conclusions: Eritrean migrant communities can be successfully reached and motivated for LTBI screening and treatment programs, when sufficient (human) resources are in place and community members, well-connected to and trusted by the community, are engaged in the design and execution of the program. Background In most low tuberculosis (TB) incidence countries, the majority (74% in the Netherlands) of TB is foreign born (1) and TB rates in this group remain high for at least 5 to 10 years after arrival.(2, 3) Therefore, to stimulate further decreases in TB incidence, prevention of TB through screening and treatment of latent TB infection (LTBI) among high-risk migrants is suggested as a strategy for low TB incidence countries.(4, 5) In the Netherlands, LTBI screening and treatment among migrants at arrival is feasible.(6, 7) Dutch TB policy advisors are therefore considering to replace current mandatory radiological TB entry-screening among migrants by LTBI screening and treatment.(4) However, this 4 policy change does not target the large pool of persons with LTBI among settled migrants, who account for 60% of annual TB patients.(8) Therefore, one can argue that this group of settled, high-TB-risk migrants can also be considered as a target group for TB prevention. Reaching and motivating migrant communities to participate in TB screening programs is not without difficulty. Barriers for screening uptake include low perceived susceptibility, stigmas and misconceptions about the disease; unfamiliarity with the concept of screening and preventive care; and limited attention to language barriers and cultural sensitivities.(9-11) To reach the population in question, engaging community members or community-based organizations, which are trusted by the community, can help overcome these barriers: they have access to the community; can channel information; educate and mobilize their community; and (hereby) alleviate stigma and promote the benefits of TB screening.(5, 10, 12-16). Therefore, designing a culturally-tailored LTBI education and screening program that engages the community and other stakeholders would be a promising way to offer LTBI screening and treatment to settled migrants.(10, 17) Since 2010, a high influx of Eritrean asylum seekers-mainly young adult men, literate but with low levels of education, and of Tigrinya ethnicity-have applied for and were granted asylum. Subsequently, many family members followed and entered the Netherlands through the family reunification program.(13) Despite a moderate estimated TB incidence rate of 89/100,000 population in Eritrea(18), this cohort of Eritrean migrants have a high TB incidence in the Netherlands.(1, 2) Therefore, they are a target population for TB prevention in the Netherlands. Although various interventions among migrant populations have been described in literature, we lack insight into which specific strategies-tailored to specific communities-will best promote the uptake of LTBI education, screening and treatment. Therefore, to reach and motivate Eritreans living in Dutch communities to participate in an LTBI education, screening and treatment program, we engaged local Eritrean key figures and TB care staff to identify and carry out tailored strategies. Methods Aim, design and setting We used a community-engaged mixed-methods study design to develop and study strategies to reach
Eurosurveillance
Background Germany has a low tuberculosis (TB) incidence. A relevant and increasing proportion of TB cases is diagnosed among asylum seekers upon screening. Aim: We aimed to assess whether cases identified by screening asylum seekers had equally successful and completely reported treatment outcomes as cases diagnosed by passive case finding and contact tracing in the general population. Methods: We analysed characteristics and treatment outcomes of pulmonary TB cases notified in Germany between 2002 and 2014, stratified by mode of case finding. We performed three multivariable analyses with different dependent variables: Model A: successful vs all other outcomes, Model B: successful vs documented non-successful clinical outcome and Model C: known outcome vs lost to follow-up. Results: TB treatment success was highest among cases identified by contact tracing (87%; 3,139/3,591), followed by passive case finding (74%; 28,804/39,019) and by screening asylum seekers (60%; 884/1,474). Ca...
BMC Infectious Diseases, 2012
Background: Screening and treatment of latent tuberculosis infection (LTBI) in asylum seekers (AS) may prevent future cases of tuberculosis. As the screening with Interferon Gamma Release Assay (IGRA) is costly, the objective of this study was to assess which factors were associated with LTBI and to define a score allowing the selection of AS with the highest risk of LTBI. Methods: In across-sectional study, AS seekers recently arrived in Vaud County, after screening for tuberculosis at the border were offered screening for LTBI with T-SPOT.TB and questionnaire on potentially risk factors. The factors associated with LTBI were analyzed by univariate and multivariate regression. Results: Among 393 adult AS, 98 (24.93%) had a positive IGRA response, five of them with active tuberculosis previously undetected. Six factors associated with LTBI were identified in multivariate analysis: origin, travel conditions, marital status, cough, age and prior TB exposure. Their combination leads to a robust LTBI predictive score. Conclusions: The prevalence of LTBI and active tuberculosis in AS is high. A predictive score integrating six factors could identify the asylum seekers with the highest risk for LTBI.
Swiss medical weekly, 2013
Preventive treatment may avoid future cases of tuberculosis among asylum seekers. The effectiveness of preventive treatment depends in large part on treatment completion. In a prospective cohort study, asylum seekers of two of the Swiss Canton Vaud migration centres were screened with the Interferon Gamma Release Assay (IGRA). Those with a positive IGRA were referred for medical examination. Individuals with active or past tuberculosis were excluded. Preventive treatment was offered to all participants with positive IGRA but without active tuberculosis. The adherence was assessed during monthly follow-up. From a population of 393 adult migrants, 98 (24.9%) had a positive IGRA. Eleven did not attend the initial medical assessment. Of the 87 examined, eight presented with pulmonary disease (five of them received a full course of antituberculous therapy), two had a history of prior tuberculosis treatment and two had contraindications to treatment. Preventive treatment was offered to 75...
Frontiers in Public Health
BackgroundThe World Health Organization (WHO) End TB strategy document ‘Toward tuberculosis elimination: an action framework for low incidence countries'—like Canada— identifies screening and treatment of latent tuberculosis infection (LTBI) for groups at increased risk for TB disease as a priority, including newcomers from endemic countries. In 2015, the clients-centered model offered at a primary care facility for refugees, BridgeCare Clinic, Winnipeg, Canada was evaluated. The model included LTBI screening, assessment, and treatment, and originally offered 9-months of isoniazid as treatment. This mixed methods evaluation investigates LTBI program outcomes since the introduction of two short-course treatment regimens: 4-months of rifampin, and 3-months of isoniazid and rifapentine.MethodsThis study combined a retrospective analysis of program administrative data with structured interviews of clinic staff. We included LTBI treatment eligibility, the treatment regimen offered, t...
2019
Background: In the Netherlands, migrant populations with a high TB incidence are an important target group for TB prevention programs. However, there is a lack of insight in community-engaged strategies to reach and motivate those migrants to participate in a latent TB infection (LTBI) education, screening and treatment program.Methods: In co-creation with Eritrean key figures and TB care staff, we designed and executed six strategies to reach and motivate Eritrean communities to participate in LTBI screening and treatment programs in five regions in the Netherlands. We registered participation in LTBI education and screening, and uptake and completion of LTBI treatment. We used semi-structured group and individual interviews with Eritrean participants and key figures, and TB care staff to identify program facilitators and barriers.Results: Uptake of LTBI education and consequent screening varied between strategies (13% - 75% and 10% - 124% respectively). The program resulted in hig...
The European respiratory journal, 2016
No evidence exists on tuberculosis (TB) and latent TB infection (LTBI) management policies among refugees in European countries.A questionnaire investigating screening and management practices among refugees was sent to 38 national TB programme representatives of low and intermediate TB incidence European countries/territories of the WHO European Region.Out of 36 responding countries, 31 (86.1%) reported screening for active TB, 19 for LTBI, and eight (22.2%) reporting outcomes of LTBI treatment. Screening for TB is based on algorithms including different combinations of symptom-based questionnaires, bacteriology and chest radiography and LTBI screening on different combinations of tuberculin skin test and interferon-γ release assays. In 22 (61.1%) countries, TB and LTBI screening are performed in refugee centres. In 22 (61.1%) countries, TB services are organised in collaboration with the private sector. 27 (75%) countries answered that screening for TB is performed as per national...
Eurosurveillance, 2022
Background Migrants in low tuberculosis (TB) incidence countries in the European Union (EU)/European Economic Area (EEA) are an at-risk group for latent tuberculosis infection (LTBI) and are increasingly included in LTBI screening programmes. Aim To investigate current approaches and implement LTBI screening in recently arrived migrants in the EU/EEA and Switzerland. Methods At least one TB expert working at a national level from the EU/EEA and one TB expert from Switzerland completed an electronic questionnaire. We used descriptive analyses to calculate percentages, and framework analysis to synthesise free-text responses. Results Experts from 32 countries were invited to participate (30 countries responded): 15 experts reported an LTBI screening programme targeting migrants in their country; five reported plans to implement one in the near future; and 10 reported having no programme. LTBI screening was predominantly for asylum seekers (n = 12) and refugees (n = 11). Twelve countri...
PLOS ONE
Background Tuberculosis (TB) is a leading cause of public health challenges among immigrant refugees and their surrounding communities in developing countries. Evaluating the treatment outcome of TB patients is one of the key indicators to understand the performance of TB control program. Hence, this study aims to assess profile, treatment outcome and factors associated with unsuccessful outcome of TB patients treated under the TB control program among refugees and their surrounding communities (SCs) in Gambella Regional State, Ethiopia. Methodology Retrospective study was conducted in the health facilities of refugee and their SCs in Gambella Regional State from March 1 to May 30, 2017. Demographic and related data of all TB patients registered in TB Control Program between September, 2008 and October, 2017 in health facilities of refugee and the SCs was extracted using data extraction format. Eight years trend of TB, treatment outcome and factors associated with unsuccessful outcome among refugees and the SCs were computed using SPSS version 20.0 software. Result A total of 886 refugees and 3284 SCs TB patients, registered for anti TB treatment in the last eight years, were evaluated in the study. The trend of all forms of TB is progressively increasing among refugees contrary to the SCs in the course of the study period (X 2 trend = 207.7; P<0.0001). Smear positive pulmonary TB (PTB+) was found to be predominant (57.6%) TB form in refugees while smear negative pulmonary TB (PTB-) (44.8%