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Pach S, Ritz N, Eisen S. Optimizing Early Diagnosis of Infectious Diseases in Migrant and Refugee Children: An Overview of Best Practices and Strategies. Pediatr Infect Dis J 2024; 43:e278-e281. [PMID: 38830140 DOI: 10.1097/inf.0000000000004406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Affiliation(s)
- Sophie Pach
- From the Paediatrics Department, Whittington Hospital, London, United Kingdom
| | - Nicole Ritz
- Paediatrics Department, Children's Hospital Central Switzerland & Faculty of Health Science and Medicine, University of Lucerne, Lucerne
- Mycobacterial and Migrant Health Research and Department for Clinical Research, University of Basel University Children's Hospital Basel, Basel, Switzerland
| | - Sarah Eisen
- Paediatrics Department, University College London Hospitals, Hospital of Tropical Diseases
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Mancy S, Fabbro-Peray P, Alonso S, Berkaoui H, Lambremon L, Vidal H, Hilaire C, Herrmann D, Dapoigny J, Kinné M. Prevalence of HIV, Hepatitis C and Hepatitis B Infection Among Detainees in a French Administrative Detention Centre. J Epidemiol Glob Health 2024:10.1007/s44197-024-00238-0. [PMID: 38739355 DOI: 10.1007/s44197-024-00238-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND In France, migrants constitute a significant proportion of people diagnosed with HIV, hepatitis C (HCV) and B (HBV). This study estimated the prevalence of these three viruses among detainees at a French administrative detention centre (CRA), through systematic Rapid Diagnostic Test (RDT) screening. METHODS This prospective, single-centre, cross-sectional, pilot study included detainees at the Nîmes CRA from February to December 2022. The primary endpoint was HIV, HCV and HBV prevalence determined by RDT. Secondary outcomes were: co-infections; study acceptability, reasons for non-inclusion, causes of non-contributory samples; and concordance between serological tests and RDT. RESULTS Among the 350 people agreeing to participate of 726 eligible, five refused the RDT, leaving 345 analysable participants for a participation rate of 47.5% (345/726). Participants were predominantly male (90%) with an average age of 31 years. The most common country of origin was Algeria (34%). Twenty (6%) had taken drugs intravenously and 240 (70%) had had unprotected sex within a median of 4.92 [1.08; 15] months. Virus prevalence was: 0% HIV; 4.64 [2.42; 6.86] % HCV; and 2.32 [1.01; 4.52] % HBV. Eleven (73%) of the RDT HCV positive cases were confirmed serologically. RDT detected one false-positive HCV case, as an anti-HCV Ac serological test was negative. Of the eight patients with positive HBV RDT, one declined the serology testing, thus 100% (7/7) of the tested RDT positive cases were confirmed by serology. CONCLUSION The study highlighted the need to screen detainees for HIV, HCV and HBV infection and suitability of RDTs.
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Affiliation(s)
- Sandrine Mancy
- Medical Unit of the Administrative Detention Centre (UMCRA), CHU Nîmes, Univ Montpellier, UMCRA 162 avenue Clément Ader, 30000, Nîmes, France.
| | - Pascale Fabbro-Peray
- Department of Biostatistics, Clinical Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Sandrine Alonso
- Department of Biostatistics, Clinical Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Hadi Berkaoui
- Medical Unit of the Administrative Detention Centre (UMCRA), CHU Nîmes, Univ Montpellier, UMCRA 162 avenue Clément Ader, 30000, Nîmes, France
| | - Laetitia Lambremon
- Medical Unit of the Administrative Detention Centre (UMCRA), CHU Nîmes, Univ Montpellier, UMCRA 162 avenue Clément Ader, 30000, Nîmes, France
| | - Hélène Vidal
- Medical Unit of the Administrative Detention Centre (UMCRA), CHU Nîmes, Univ Montpellier, UMCRA 162 avenue Clément Ader, 30000, Nîmes, France
| | - Christophe Hilaire
- Medical Unit of the Administrative Detention Centre (UMCRA), CHU Nîmes, Univ Montpellier, UMCRA 162 avenue Clément Ader, 30000, Nîmes, France
| | - Dorine Herrmann
- Medical Unit of the Administrative Detention Centre (UMCRA), CHU Nîmes, Univ Montpellier, UMCRA 162 avenue Clément Ader, 30000, Nîmes, France
| | - Jennifer Dapoigny
- Medical Unit of the Administrative Detention Centre (UMCRA), CHU Nîmes, Univ Montpellier, UMCRA 162 avenue Clément Ader, 30000, Nîmes, France
| | - Melanie Kinné
- Medical Unit of the Administrative Detention Centre (UMCRA), CHU Nîmes, Univ Montpellier, UMCRA 162 avenue Clément Ader, 30000, Nîmes, France
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Palich R, Arias-Rodríguez A, Duracinsky M, Le Talec JY, Rousset Torrente O, Lascoux-Combe C, Lacombe K, Ghosn J, Viard JP, Pialoux G, Ohayon M, Duvivier C, Velter A, Ben Mechlia M, Beniguel L, Grabar S, Melchior M, Assoumou L, Supervie V. High proportion of post-migration HIV acquisition in migrant men who have sex with men receiving HIV care in the Paris region, and associations with social disadvantage and sexual behaviours: results of the ANRS-MIE GANYMEDE study, France, 2021 to 2022. Euro Surveill 2024; 29:2300445. [PMID: 38487889 PMCID: PMC10941311 DOI: 10.2807/1560-7917.es.2024.29.11.2300445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 01/03/2024] [Indexed: 03/17/2024] Open
Abstract
BackgroundSome migrant men who have sex with men (MSM) acquire HIV in France.AimsWe investigated, in migrant MSM receiving HIV care in France, the (i) rate of post-migration-HIV acquisition in France, (ii) delay between arrival and HIV acquisition and (iii) factors affecting HIV acquisition within 1 year after migration.MethodsThis cross-sectional study focused on ≥ 18-year-old MSM born outside France, receiving HIV care in the Paris region. Information on migration history, socioeconomic condition, sexual activity, and health was collected in May 2021-June 2022 through self-administered questionnaires and medical records. Post-migration-HIV-acquisition rate and delay between arrival in France and HIV acquisition were estimated from biographical data and CD4+ T-cell counts. Predictors of HIV acquisition within 1 year after migration were determined using logistic regression.ResultsOverall post-migration HIV-acquisition rate was 61.7% (715/1,159; 95%CI: 61.2-62.2), ranging from 40.5% (95%CI: 39.6-41.6) to 85.4% (95%CI: 83.9-86.0) in participants from Latin America and North Africa. Among post-migration-HIV acquisitions, those within 1 year after migration represented 13.1% overall (95%CI: 11.6-14.6), being highest in participants from sub-Saharan Africa (25%; 95%CI: 21.5-28.3). Participants ≥ 15-years old at migration, with post-migration-acquired HIV, had a 7.5-year median interval from arrival in France to HIV acquisition (interquartile range (IQR): 3.50-14.75). Older age at arrival, region of origin (sub-Saharan Africa and Asia), degree of social disadvantage and numbers of sexual partners were independently associated with acquiring HIV within 1 year in France.ConclusionOur findings may guide HIV prevention policies for most vulnerable migrants to Europe.
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Affiliation(s)
- Romain Palich
- Sorbonne University, Pitié-Salpêtrière hospital, AP-HP, Paris, France
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
| | - Andrés Arias-Rodríguez
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
| | - Martin Duracinsky
- Paris Cité University, Patient-Reported Outcomes Unit (PROQOL), INSERM 1123, Paris, France
| | - Jean-Yves Le Talec
- Toulouse Jean Jaurès University, CERTOP, CNRS UMR 5044, Toulouse, France
| | | | | | - Karine Lacombe
- Sorbonne University, Saint Antoine hospital, AP-HP, Paris, France
| | - Jade Ghosn
- Paris Cité University, Bichat hospital, AP-HP, Paris, France
| | - Jean-Paul Viard
- Paris Cité University, Hôtel-Dieu hospital, AP-HP, Paris, France
| | - Gilles Pialoux
- Sorbonne University, Tenon hospital, AP-HP, Paris, France
| | | | - Claudine Duvivier
- Paris Cité University, Necker hospital, AP-HP; INSERM U1016, CNRS UMR8104, Institut Cochin; IHU Imagine; Institut Pasteur Medical Center, Paris, France
| | | | - Mohamed Ben Mechlia
- French National Agency for Research on AIDS, Viral Hepatitis and Emerging Infectious Diseases (ANRS-MIE), Paris, France
| | - Lydie Beniguel
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
| | - Sophie Grabar
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
| | - Maria Melchior
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
| | - Lambert Assoumou
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
| | - Virginie Supervie
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
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Simonek T, Zahos H, Mahroof-Shaffi S, Harkensee C. Seasonal patterns of communicable disease incidence and antibiotic prescribing in Moria refugee camp, Greece. J Public Health (Oxf) 2024; 46:41-50. [PMID: 37968097 DOI: 10.1093/pubmed/fdad212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/27/2023] [Accepted: 10/19/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Infectious diseases remain a major risk for refugees living in camps. Limited research has been undertaken into the burden and impact of infections in the current refugee crisis around the Mediterranean.This analysis examines the frequency and incidence rates of common infections, and use of antibiotics at a healthcare facility inside Moria refugee camp on the island of Lesvos, Greece, during the winter and summer seasons of 2019. METHODS This is a retrospective analysis of routinely, prospectively collected service data from the main acute healthcare facility inside Moria camp. RESULTS Of a total of 9601 consultations, 25.16% were for infections (winter: 31.53%, summer: 19.45%). Respiratory, skin and gastrointestinal infections were the most frequent, with incidence rates up to 3.5 times, 50 times and twice as high as those in Western Europe, respectively. Antibiotic prescribing was high (27.7% of all respiratory infections) with high use of broad-spectrum antibiotics (40.2%), raising concerns about induction of antimicrobial resistance. CONCLUSIONS The burden of infectious diseases in refugee camps remains high throughout all seasons. Antimicrobial stewardship programmes should be adapted to refugee camp settings to prevent the development of unnecessary antimicrobial resistance. Improving living conditions and access to healthcare in refugee camps is likely to reduce infection rates and antimicrobial resistance among refugees.
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Affiliation(s)
- Tomas Simonek
- UNHCR Camp Lesbos Greece, St. Elizabeth University, Namestie, 1 Maja 1, 81000 Bratislava, Slovakia
| | - Helen Zahos
- School of Nursing and Midwifery, Griffith University, Parklands Drive, Southport, QLD 4222, Gold Coast, Australia
| | | | - Christian Harkensee
- Queen Elizabeth Hospital Gateshead, Queen Elizabeth Avenue, Gateshead, NE9 6SX, UK
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Rossoni I, Chollier M, Dudushi R, Ghigo J, Padovese V. A scoping review of sexual and reproductive health recommendations in the context of migration to Europe. J Eur Acad Dermatol Venereol 2023; 37:2450-2461. [PMID: 37591613 DOI: 10.1111/jdv.19428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 07/21/2023] [Indexed: 08/19/2023]
Abstract
In recent years, growing instability and conflict around the world have continued to fuel outward migration, including migration to the EU/EEA. Many migrants hail from countries and regions with a higher burden of STIs-including HIV-and are exposed to enhanced risks of sexual and gender-based violence leading to sexual health issues during their journeys. This scoping review aims to identify existing sexual health recommendations for non-European migrants in the EU/EEA and identify gaps in their implementation. Sexual health recommendations formulated in relation to the migrant population in peer- reviewed journals or by expert consensus, between 2010 and 2021, were included. A keyword search was used to retrieve relevant publications on PubMed, ScienceDirect, the Cochrane Library databases, WHO and ECDC websites. The search strategy employed was charted in a dedicated Prisma Chart. Overall, 180 publications were retrieved. Based on the abstract and after eliminating duplicates, 33 publications were included for full-text reading. The references of these publications were screened. In total, 19 publications met the inclusion criteria. Evidence-based sexual health recommendations target only newly arrived migrants and migrant children (at arrival and during stay in the country). Screening practices are mostly informed by the country of origin and related prevalence, which remains a limitation; challenges faced during migration should also be considered. Implementation and compliance with these recommendations remain uncertain, as sexual health is not funded and addressed in a uniform manner across Europe.
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Affiliation(s)
- I Rossoni
- Van Vollenhoven Institute for Law, Governance and Society, Leiden University, Leiden, The Netherlands
| | - M Chollier
- CRIR-AVS PACA, APHM, Marseille, France
- UNESCO Chair for Sexual Health and Human Rights, Paris, France
| | - R Dudushi
- Faculty of Social Sciences, University of Tirana, Tirana, Albania
| | - J Ghigo
- Department of Obstetrics and Gynecology, Mater Dei Hospital, Msida, Malta
| | - V Padovese
- Genitourinary Clinic, Department of Dermatology and Venereology, Mater Dei Hospital, Msida, Malta
- International Foundation for Dermatology, Migrant Health Dermatology Working Group, London, UK
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Carter J, Knights F, Deal A, Crawshaw AF, Hayward SE, Hall R, Matthews P, Seedat F, Ciftci Y, Zenner D, Wurie F, Campos-Matos I, Majeed A, Requena-Mendez A, Hargreaves S. Multi-infection screening for migrant patients in UK primary care: Challenges and opportunities. J Migr Health 2023; 9:100203. [PMID: 38059072 PMCID: PMC10696453 DOI: 10.1016/j.jmh.2023.100203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/28/2023] [Indexed: 12/08/2023] Open
Abstract
Background Migrants in Europe face a disproportionate burden of undiagnosed infection, including tuberculosis, blood-borne viruses, and parasitic infections and many belong to an under-immunised group. The European Centre for Disease Control (ECDC) has called for innovative strategies to deliver integrated multi-disease screening to migrants within primary care, yet this is poorly implemented in the UK. We did an in-depth qualitative study to understand current practice, barriers and solutions to infectious disease screening in primary care, and to seek feedback on a collaboratively developed digitalised integrated clinical decision-making tool called Health Catch UP!, which supports multi-infection screening for migrant patients. Methods Two-phase qualitative study of UK primary healthcare professionals, in-depth semi-structured telephone-interviews were conducted. In Phase A, we conducted interviews with clinical staff (general practitioners (GPs), nurses, health-care-assistants (HCAs)); these informed data collection and analysis for phase B (administrative staff). Data were analysed iteratively, using thematic analysis. Results In phase A, 48 clinicians were recruited (25 GPs, 15 nurses, seven HCAs, one pharmacist) and 16 administrative staff (11 Practice-Managers, five receptionists) in phase B. Respondents were positive about primary care's ability to effectively deliver infectious disease screening. However, we found current infectious disease screening lacks a standardised approach and many practices have no system for screening meaning migrant patients are not always receiving evidence-based care (i.e., NICE/ECDC/UKHSA screening guidelines). Barriers to screening were reported at patient, staff, and system-levels. Respondents reported poor implementation of existing screening initiatives (e.g., regional latent TB screening) citing overly complex pathways that required extensive administrative/clinical time and lacked financial/expert support. Solutions included patient/staff infectious disease champions, targeted training and specialist support, simplified care pathways for screening and management of positive results, and financial incentivisation. Participants responded positively to Health Catch-UP!, stating it would systematically integrate data and support clinical decision-making, increase knowledge, reduce missed screening opportunities, and normalisation of primary care-based infectious disease screening for migrants. Conclusions Our results suggest that implementation of infectious disease screening in migrant populations is not comprehensively done in UK primary care. Primary health care professionals support the concept of innovative digital tools like Health Catch-UP! and that they could significantly improve disease detection and effective implementation of screening guidance but that they require robust testing and resourcing.
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Affiliation(s)
- Jessica Carter
- The Migrant Health Research Group, St George's, University of London, London, United Kingdom
| | - Felicity Knights
- The Migrant Health Research Group, St George's, University of London, London, United Kingdom
| | - Anna Deal
- The Migrant Health Research Group, St George's, University of London, London, United Kingdom
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Alison F Crawshaw
- The Migrant Health Research Group, St George's, University of London, London, United Kingdom
| | - Sally E Hayward
- The Migrant Health Research Group, St George's, University of London, London, United Kingdom
| | | | | | - Farah Seedat
- The Migrant Health Research Group, St George's, University of London, London, United Kingdom
| | | | - Dominik Zenner
- Global Public Health Unit, Wolfson Institute of Population Health, United Kingdom
| | - Fatima Wurie
- Department of Health and Social Care, Office for Health Improvement and Disparities, United Kingdom
| | - Ines Campos-Matos
- Department of Health and Social Care, Addictions and Inclusion Directorate, Office for Health Improvement and Disparities, United Kingdom
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, United Kingdom
| | - Ana Requena-Mendez
- Barcelona Institute for Global Health (ISGlobal Campus Clinic), Spain
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Sally Hargreaves
- The Migrant Health Research Group, St George's, University of London, London, United Kingdom
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Amarasena L, Zwi K, Hu N, Lingam R, Raman S. Changing landscape of paediatric refugee health in South Western Sydney, Australia: a retrospective observational study. BMJ Open 2023; 13:e064497. [PMID: 37852766 PMCID: PMC10603544 DOI: 10.1136/bmjopen-2022-064497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 07/04/2023] [Indexed: 10/20/2023] Open
Abstract
OBJECTIVES To examine the changing health needs of refugee children and young people (CYP) entering Australia, in relation to key government policy changes. STUDY DESIGN Retrospective analysis of health service use data over 11 years. SETTING Paediatric refugee clinics in South Western Sydney (SWS), the Australian region with the largest annual resettlement of refugees. PARTICIPANTS Refugee CYP (≤25 years) attending the SWS paediatric refugee clinics for their first visit between 2009 and 2019. MEASURES Clinician defined health conditions categorised as communicable and non-communicable disease (NCD). RESULTS Data were analysed for 359 CYP, mean age 9.3 years; 212 male (59.1%). Most CYP (n=331, 92.2%) had health problems identified; 292 (81.3%) had ≥1 NCD and 24 (6.7%) had ≥1 communicable disease. The most frequent individual NCDs were dental disease (n=128, 35.7%) and vitamin D deficiency (n=72, 20.1%). Trend analysis showed increased odds of identifying an NCD from 2013 onwards (crude OR 1.77, 95% CI 1.06 to 2.96). Neurodevelopmental problems, especially Global Developmental Delay (n=31, 8.6%), emerged as more prevalent issues in the latter half of the decade. There were significantly increased odds of identifying a neurodevelopmental problem in 2016-2019, especially in 2016-2017 (adjusted OR 2.93, 95% CI 1.34 to 6.40). Key policy changes during this period included acceptance of refugees with disabilities from 2012, additional Australian Humanitarian Programme intake from the Eastern Mediterranean region and mandatory offshore processing for those seeking asylum by boat from 2013. In response to the changing needs, local health services adopted nurse-led primary healthcare screening, early childhood services, youth and disability clinics. CONCLUSIONS Refugee CYP in Australia are presenting with a growing burden of NCDs, with neurodevelopmental problems contributing. Government policy changes affect the sociodemographics of resettled populations, influencing health profiles. Paediatric refugee health services need to be responsive to the changing needs of these populations to optimise well-being.
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Affiliation(s)
- Lahiru Amarasena
- School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Karen Zwi
- School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
- Department of Community Child Health, Sydney Children's Hospitals Network Randwick and Westmead, Sydney, New South Wales, Australia
| | - Nan Hu
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Raghu Lingam
- School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
- Department of Community Child Health, Sydney Children's Hospitals Network Randwick and Westmead, Sydney, New South Wales, Australia
| | - Shanti Raman
- School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
- Department of Community Paediatrics, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
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Arvidsson Å, Lafta G, Sönnerbrandt M, Sundelin K, Paues J. The cascade of care for pregnant women with latent tuberculosis infection in a high-income country. Infect Dis (Lond) 2023; 55:635-645. [PMID: 37389825 DOI: 10.1080/23744235.2023.2228406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/16/2023] [Accepted: 06/16/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Pregnant women have an increased risk of developing active tuberculosis (TB). The Public Health Agency of Sweden recommends screening of active TB and latent tuberculosis infection (LTBI) among pregnant women from countries with high TB incidence at Maternal Health Care (MHC) clinics. In Östergötland County, Sweden, a screening program has been active since 2013. The aim of this study was to evaluate this screening program and the cascade of care for LTBI among pregnant women in Östergötland county. METHODS Data were obtained from pregnant women screened for TB at MHC clinics and subsequently referred to the pulmonary medicine clinic or the clinic of infectious diseases in Östergötland County between 2013 and 2018. The Public Health Agency of Sweden's national database for active TB was used to analyse if any women developed active TB up to two years after the screening process. RESULTS A total of 439 women were included. Nine cases of active TB were discovered during the screening process and two developed active TB afterward. 177 women were recommended LTBI treatment and variables significantly associated with a decreased likelihood of being recommended treatment were increasing age, time in Sweden, and parity. 137 women received and 112 (82%) completed treatment. 14 women discontinued treatment due to adverse effects. CONCLUSION Screening of pregnant women from countries with high TB incidence at MHC clinics led to the discovery of several cases of active TB. The completion rate of LTBI treatment was high and few discontinued due to adverse effects.
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Affiliation(s)
- Åsa Arvidsson
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Gihan Lafta
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | | | - Karin Sundelin
- Department for Infectious Diseases, Region Östergötland, Linköping, Sweden
| | - Jakob Paues
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- Department for Infectious Diseases, Region Östergötland, Linköping, Sweden
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Reyes-Urueña J, Costell-González F, Egea-Cortés L, Ouaarab H, Saludes V, Buti M, Majó I Roca X, Colom J, Gómez I Prat J, Casabona J, Martro E. Implementation of the HepC link test-and-treat community strategy targeting Pakistani migrants with hepatitis C living in Catalonia (Spain) compared with the current practice of the Catalan health system: budget impact analysis. BMJ Open 2023; 13:e068460. [PMID: 37604632 PMCID: PMC10445371 DOI: 10.1136/bmjopen-2022-068460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 07/23/2023] [Indexed: 08/23/2023] Open
Abstract
OBJECTIVES To perform a budget impact analysis of the HepClink test-and-treat strategy in which community health agents offer hepatitis C virus (HCV) testing, diagnosis and treatment to the Pakistani population living in Catalonia compared with the current practice of the Catalan health system (without targeted screening programmes). METHODS We estimated the population of adult Pakistani migrants registered at the primary care centres in Catalonia by means of the Information System for the Development of Research in Primary Care (n=37 972 in 2019, Barcelona health area). This cohort was followed for a time period of 10 years after HCV diagnosis (2019-2028). The statistical significance of the differences observed in the anti-HCV positivity rate between screened and non-screened was confirmed (α=0.05). The budget impact was calculated from the perspective of the Catalan Department of Health. Sensitivity analyses included different levels of participation in HepClink: pessimistic, optimistic and maximum. RESULTS The HepClink scenario screened a higher percentage of individuals (69.8%) compared with the current scenario of HCV care (39.7%). Viraemia was lower in the HepClink scenario compared with the current scenario (1.7% vs 2.5%, respectively). The budget impact of the HepClink scenario was €884 244.42 in 10 years. CONCLUSIONS Scaling up the HepClink strategy to the whole Catalan territory infers a high budget impact for the Department of Health and allows increasing the detection of viraemia (+17.8%) among Pakistani migrants ≥18 years. To achieve a sustainable elimination of HCV by improving screening and treatment rates, there is room for improvement at two levels. First, taking advantage of the fact that 68.08% of the Pakistani population had visited their primary care physicians to reinforce targeted screening in primary care. Second, to use HepClink at the community level to reach individuals with reluctance to use healthcare services.
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Affiliation(s)
- Juliana Reyes-Urueña
- Centre for Epidemiological Studies on STD/HIV/SIDA of Catalonia, Public Health Agency of Catalonia, Badalona, Spain
| | - Francisco Costell-González
- Centre for Epidemiological Studies on STD/HIV/SIDA of Catalonia, Public Health Agency of Catalonia, Badalona, Spain
| | - Laia Egea-Cortés
- Centre for Epidemiological Studies on STD/HIV/SIDA of Catalonia, Public Health Agency of Catalonia, Badalona, Spain
| | - Hakima Ouaarab
- Unitat de Salut Internacional Vall Hebrón-Drassanes, Hospital Universitario Vall Hebrón, Barcelona, Spain
| | - Veronica Saludes
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Maria Buti
- Servicio de Hepatología, Hospital Universitario Vall Hebrón, Barcelona, Spain
| | - Xavier Majó I Roca
- Programa de prevenció, control i atenció al virus d'immunodeficiència humana (VIH), les infeccions de transmissió sexual (ITS) i les hepatitis víriques (HV) (PCVIHV), Public Health Agency of Catalonia, Barcelona, Spain
| | - Joan Colom
- Programa de prevenció, control i atenció al virus d'immunodeficiència humana (VIH), les infeccions de transmissió sexual (ITS) i les hepatitis víriques (HV) (PCVIHV), Public Health Agency of Catalonia, Barcelona, Spain
| | - Jordi Gómez I Prat
- Unitat de Salut Internacional Vall Hebrón-Drassanes, Hospital Universitario Vall Hebrón, Barcelona, Spain
| | - Jordi Casabona
- Centre for Epidemiological Studies on STD/HIV/SIDA of Catalonia, Public Health Agency of Catalonia, Badalona, Spain
| | - Elisa Martro
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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10
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Jiang J, Zhou Y, Xu J, Wang Z. The Vulnerability of International Floating Populations to Sexually Transmitted Infections: A Qualitative Study. Healthcare (Basel) 2023; 11:1744. [PMID: 37372862 DOI: 10.3390/healthcare11121744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
With the rapid development of the global economy, along with globalisation, the health of international floating populations (especially their sexual health) has become a problem that cannot be ignored. This study explored the potential vulnerability of international floating populations to sexually transmitted infections (STIs) from the points of view of society, religion, culture, migration, community environment, and personal behaviours. In-depth exploratory interviews with 51 members of the international floating population living in China were conducted in June and July 2022. A qualitative thematic analysis methodology was used to analyse the content of these interviews. We found that a conservative culture orientated around religion leads to a lack of sex education, resulting in insufficient personal knowledge as well as a lack of the motivation and awareness required to encourage condom use during sexual contact. Additionally, both geographical isolation and reduced social supervision have expanded personal space, which has led to social isolation and marginalisation, in addition to challenges for coping with STI risk. These factors have increased the possibility of individuals engaging in risky behaviours.
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Affiliation(s)
- Jiahan Jiang
- School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Yuyin Zhou
- School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Junfang Xu
- School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Zhaochen Wang
- School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China
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11
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Bird PW, Holmes CW, Pan D, Martin CA, Pareek M, Gogoi M, Sandhu R, Sargeant P, McMurray CL, Baggaley RF, Nellums LB. Awareness of HIV, hepatitis B, hepatitis C, tuberculosis and COVID-19 in migrant students in the UK: a pilot survey from an Institute of Higher Education. J Infect 2023; 86:e94-e96. [PMID: 36796680 PMCID: PMC9925411 DOI: 10.1016/j.jinf.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023]
Affiliation(s)
- Paul W Bird
- Department of Microbiology, University Hospitals of Leicester NHS Trust, UK; Department of Respiratory Sciences, University of Leicester, UK
| | - Christopher W Holmes
- Department of Microbiology, University Hospitals of Leicester NHS Trust, UK; Department of Respiratory Sciences, University of Leicester, UK
| | - Daniel Pan
- Department of Respiratory Sciences, University of Leicester, UK; Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, UK
| | - Christopher A Martin
- Department of Respiratory Sciences, University of Leicester, UK; Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, UK
| | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, UK; Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, UK.
| | - Mayuri Gogoi
- Department of Respiratory Sciences, University of Leicester, UK
| | | | | | - Claire L McMurray
- Department of Microbiology, University Hospitals of Leicester NHS Trust, UK
| | | | - Laura B Nellums
- Faculty of Medicine & Health Sciences, University of Nottingham, UK
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12
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Martyn E, Eisen S, Longley N, Harris P, Surey J, Norman J, Brown M, Sultan B, Maponga TG, Iwuji C, Flanagan S, Ghosh I, Story A, Matthews PC. The forgotten people: Hepatitis B virus (HBV) infection as a priority for the inclusion health agenda. eLife 2023; 12:e81070. [PMID: 36757862 PMCID: PMC9910830 DOI: 10.7554/elife.81070] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/19/2023] [Indexed: 02/10/2023] Open
Abstract
Hepatitis B virus (HBV) infection represents a significant global health threat, accounting for 300 million chronic infections and up to 1 million deaths each year. HBV disproportionately affects people who are under-served by health systems due to social exclusion, and can further amplify inequities through its impact on physical and mental health, relationship with stigma and discrimination, and economic costs. The 'inclusion health' agenda focuses on excluded and vulnerable populations, who often experience barriers to accessing healthcare, and are under-represented by research, resources, interventions, advocacy, and policy. In this article, we assimilate evidence to establish HBV on the inclusion health agenda, and consider how this view can inform provision of better approaches to diagnosis, treatment, and prevention. We suggest approaches to redress the unmet need for HBV interventions among excluded populations as an imperative to progress the global goal for the elimination of viral hepatitis as a public health threat.
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Affiliation(s)
- Emily Martyn
- The Francis Crick InstituteLondonUnited Kingdom
- London School of Hygiene & Tropical MedicineLondonUnited Kingdom
- Hospital for Tropical Diseases, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Sarah Eisen
- Hospital for Tropical Diseases, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Nicky Longley
- London School of Hygiene & Tropical MedicineLondonUnited Kingdom
- Hospital for Tropical Diseases, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Department of Infectious Diseases, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Philippa Harris
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Julian Surey
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Institute of Global Health, University College LondonLondonUnited Kingdom
- Universidad Autonoma de Madrid, Ciudad Universitaria de CantoblancoMadridSpain
| | - James Norman
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Michael Brown
- London School of Hygiene & Tropical MedicineLondonUnited Kingdom
- Department of Infectious Diseases, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Binta Sultan
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Mortimer Market Centre, Central and North London NHS Foundation TrustLondonUnited Kingdom
| | - Tongai G Maponga
- Stellenbosch University, Faculty of Medicine and Health SciencesTygerbergSouth Africa
| | - Collins Iwuji
- Department of Global Health, Brighton and Sussex Medical School, University of SussexBrightonUnited Kingdom
- Africa Health Research InstituteDurban, KwaZulu-NatalSouth Africa
| | - Stuart Flanagan
- Mortimer Market Centre, Central and North London NHS Foundation TrustLondonUnited Kingdom
| | - Indrajit Ghosh
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Mortimer Market Centre, Central and North London NHS Foundation TrustLondonUnited Kingdom
| | - Alistair Story
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Collaborative Centre for Inclusion Health, University College LondonLondonUnited Kingdom
| | - Philippa C Matthews
- The Francis Crick InstituteLondonUnited Kingdom
- Department of Infectious Diseases, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Mortimer Market Centre, Central and North London NHS Foundation TrustLondonUnited Kingdom
- Division of Infection and Immunity, University College LondonLondonUnited Kingdom
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13
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Moonen CPB, den Heijer CDJ, Dukers-Muijrers NHTM, van Dreumel R, Steins SCJ, Hoebe CJPA. A systematic review of barriers and facilitators for hepatitis B and C screening among migrants in the EU/EEA region. Front Public Health 2023; 11:1118227. [PMID: 36875381 PMCID: PMC9975596 DOI: 10.3389/fpubh.2023.1118227] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/31/2023] [Indexed: 02/17/2023] Open
Abstract
Introduction Hepatitis B and C are a threat to public health. Screening of high-risk groups, such as migrants from high-endemic areas, enables early identification and treatment initiation. This systematic review identified barriers and facilitators for hepatitis B and C screening among migrants in the European Union/European Economic Area (EU/EEA). Methods Following PRISMA guidelines, databases PubMed, Embase via Ovid, and Cochrane were searched for English articles published between 1 July 2015 and 24 February 2022. Articles were included, not restricted to a specific study design, if they elaborated on HBV or HCV screening in migrant populations from countries outside Western Europe, North America, and Oceania, and residing in EU/EEA countries. Excluded were studies with solely an epidemiological or microbiological focus, including only general populations or non-migrant subgroups, or conducted outside the EU/EEA, without qualitative, quantitative, or mixed methods. Data appraisal, extraction, and quality assessment were conducted and assessed by two reviewers. Barriers and facilitators were categorized into seven levels based on multiple theoretical frameworks and included factors related to guidelines, the individual health professional, the migrant and community, interaction, the organization and economics, the political and legal level, and innovations. Results The search strategy yielded 2,115 unique articles of which 68 were included. Major identified barriers and facilitators to the success of screening related to the migrant (knowledge and awareness) and community level (culture, religion, support) and the organizational and economic level (capacity, resources, coordinated structures). Given possible language barriers, language support and migrant sensitivity are indispensable for facilitating interaction. Rapid point-of-care-testing is a promising strategy to lower screening barriers. Discussion The inclusion of multiple study designs provided extensive insight into barriers, strategies to lower these barriers, and facilitators to maximize the success of screening. A great variety of factors were revealed on multiple levels, therefore there is no one-size-fits-all approach for screening, and initiatives should be adopted for the targeted group(s), including tailoring to cultural and religious beliefs. We provide a checklist of facilitators and barriers to inform adapted interventions to allow for optimal screening impact.
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Affiliation(s)
- Chrissy P B Moonen
- Living Lab Public Health, Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands.,Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Casper D J den Heijer
- Living Lab Public Health, Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands.,Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Nicole H T M Dukers-Muijrers
- Living Lab Public Health, Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands.,Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Ragni van Dreumel
- Living Lab Public Health, Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands
| | - Sabine C J Steins
- Living Lab Public Health, Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands
| | - Christian J P A Hoebe
- Living Lab Public Health, Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands.,Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands.,Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
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14
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Wei Y, Zhang R, Li T, Ye L, Lin L. Prevention and Initial Management of HIV Infection. Ann Intern Med 2022; 175:W152. [PMID: 36534991 DOI: 10.7326/l22-0394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Yongbao Wei
- Fujian Medical University and Fujian Provincial Hospital, Fuzhou, China
| | - Ruochen Zhang
- Fujian Medical University and Fujian Provincial Hospital, Fuzhou, China
| | - Tao Li
- Fujian Medical University and Fujian Provincial Hospital, Fuzhou, China
| | - Liefu Ye
- Fujian Medical University and Fujian Provincial Hospital, Fuzhou, China
| | - Le Lin
- Fujian Medical University and Fujian Provincial Hospital, Fuzhou, China
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15
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Nissen RP, Frederiksen H, Brande S, Norredam M. The general health status of newly arrived asylum seekers in Denmark. Scand J Public Health 2022:14034948221136366. [DOI: 10.1177/14034948221136366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims: The number of asylum seekers in Europe is increasing and is likely to do so continuously due to conflicts, poverty and climate. Asylum seekers are exposed to many health risk factors related to their migration process and this study aimed to explore their general health status on arrival at an immigration country. Methods: A retrospective study including 1907 general health assessments (GHAs) of adult asylum seekers arriving in Denmark between 1 September 2017 and 31 December 2019 was undertaken. The GHA is offered to all adult asylum seekers as part of the health-care reception programme. Only asylum seekers who attended the GHA within 1 month of their arrival in Denmark were included. Data comprised sociodemographic factors, health outcomes, and indication of exposure to trauma and torture. Data were described by absolute and relative frequencies, means and through regression analyses. Results: The majority of asylum seekers were male (58.6%) of Middle Eastern origin with a mean age of 33.6 years (SD = 12.1). More than half (60.1%) of the participants had one or more physical health complaints, whereas mental health complaints were less frequent (25.0%). Asylum seekers, who had been exposed to trauma were more likely to have physical health complaints (OR 1.52, 95% CI 1.22;1.89) and to have symptoms of mental health problems (OR 12.71, 95% CI 8.76;18.45). These complaints were substantially elevated for survivors of torture. Conclusions: This relatively high prevalence of health complaints, both physical and mental, emphasises the necessity of providing appropriate and timely health care from the very beginning of the asylum process.
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Affiliation(s)
- R. Primdahl Nissen
- Danish Research Centre for Migration, Ethnicity and Health, Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
| | - H.W. Frederiksen
- Section of Immigrant Medicine, Department of Infectious Diseases, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - S.E. Brande
- Danish Patient Safety Authority, Copenhagen, Denmark
| | - M. Norredam
- Danish Research Centre for Migration, Ethnicity and Health, Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
- Section of Immigrant Medicine, Department of Infectious Diseases, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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16
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Yudintceva N, Mikhailova N, Fedorov V, Samochernych K, Vinogradova T, Muraviov A, Shevtsov M. Mesenchymal Stem Cells and MSCs-Derived Extracellular Vesicles in Infectious Diseases: From Basic Research to Clinical Practice. Bioengineering (Basel) 2022; 9:662. [PMID: 36354573 PMCID: PMC9687734 DOI: 10.3390/bioengineering9110662] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/30/2022] [Accepted: 11/04/2022] [Indexed: 08/10/2023] Open
Abstract
Mesenchymal stem cells (MSCs) are attractive in various fields of regenerative medicine due to their therapeutic potential and complex unique properties. Basic stem cell research and the global COVID-19 pandemic have given impetus to the development of cell therapy for infectious diseases. The aim of this review was to systematize scientific data on the applications of mesenchymal stem cells (MSCs) and MSC-derived extracellular vesicles (MSC-EVs) in the combined treatment of infectious diseases. Application of MSCs and MSC-EVs in the treatment of infectious diseases has immunomodulatory, anti-inflammatory, and antibacterial effects, and also promotes the restoration of the epithelium and stimulates tissue regeneration. The use of MSC-EVs is a promising cell-free treatment strategy that allows solving the problems associated with the safety of cell therapy and increasing its effectiveness. In this review, experimental data and clinical trials based on MSCs and MSC-EVs for the treatment of infectious diseases are presented. MSCs and MSC-EVs can be a promising tool for the treatment of various infectious diseases, particularly in combination with antiviral drugs. Employment of MSC-derived EVs represents a more promising strategy for cell-free treatment, demonstrating a high therapeutic potential in preclinical studies.
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Affiliation(s)
- Natalia Yudintceva
- Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg 194064, Russia
- Personalized Medicine Centre, Almazov National Medical Research Centre, St. Petersburg 197341, Russia
| | - Natalia Mikhailova
- Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg 194064, Russia
| | - Viacheslav Fedorov
- Personalized Medicine Centre, Almazov National Medical Research Centre, St. Petersburg 197341, Russia
| | - Konstantin Samochernych
- Personalized Medicine Centre, Almazov National Medical Research Centre, St. Petersburg 197341, Russia
| | - Tatiana Vinogradova
- Saint-Petersburg State Research Institute of Phthisiopulmonology of the Ministry of Health of the Russian Federation, St. Petersburg 191036, Russia
| | - Alexandr Muraviov
- Saint-Petersburg State Research Institute of Phthisiopulmonology of the Ministry of Health of the Russian Federation, St. Petersburg 191036, Russia
| | - Maxim Shevtsov
- Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg 194064, Russia
- Personalized Medicine Centre, Almazov National Medical Research Centre, St. Petersburg 197341, Russia
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17
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Greenaway C, Hargreaves S. Improving screening and treatment for infectious diseases in migrant populations. J Travel Med 2022; 29:6747787. [PMID: 36193748 DOI: 10.1093/jtm/taac115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 11/15/2022]
Abstract
Many migrants living in high-income countries have increased morbidity and mortality due to undetected and untreated infections. Improving and strengthening the care continuum (screening and linkage to care and treatment) and building migrant-friendly health systems that improve access to care will be required to address this health disparity.
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Affiliation(s)
- Christina Greenaway
- Division of Infectious Disease, Jewish General Hospital, Montreal, H3T1E2 Quebec, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, H3T 1E2 Quebec, Canada.,Department of Medicine, McGill University, Montreal, H3G Quebec, Canada
| | - Sally Hargreaves
- Centre for Global Health, Institute for Infection and Immunity, St George's University of London, UK
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18
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Prevention and treatment of infectious diseases in migrants in Europe in the era of universal health coverage. THE LANCET PUBLIC HEALTH 2022; 7:e876-e884. [DOI: 10.1016/s2468-2667(22)00174-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/16/2022] [Accepted: 07/04/2022] [Indexed: 11/20/2022] Open
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19
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Kamenshchikova A, Hargreaves S, Chandler CIR. Management of cross-border mobilities during the SARS-CoV-2 pandemic in Europe and implications for public health provision to migrants. J Travel Med 2022; 29:6657743. [PMID: 35932458 PMCID: PMC9384629 DOI: 10.1093/jtm/taac093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022]
Abstract
While many countries introduced border control measures to prevent the spread of SARS-CoV-2, migrants on the move, like labour migrants and asylum seekers were trapped within the developing border politics. Here, we discuss how pre-existing gaps in international public health infrastructures have positioned migrants at a higher risk of SARS-CoV-2.
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Affiliation(s)
- Alena Kamenshchikova
- Department of Health, Ethics and Society, School of Public Health and Primary Care, Maastricht University, Maastricht, MD 6200, The Netherlands.,Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK
| | - Sally Hargreaves
- Institute for Infection and Immunity, St George's, University of London, London, SW17 0RE, UK
| | - Clare I R Chandler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK
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20
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Langholz Kristensen K, Norredam M, Graff Jensen S, Seersholm N, Jørgensen ML, Exsteen BB, Huber FG, Munk-Andersen E, Lillebaek T, Ravn P. Tuberculosis screening among newly arrived asylum seekers in Denmark. Infect Dis (Lond) 2022; 54:819-827. [PMID: 36000199 DOI: 10.1080/23744235.2022.2106380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) screening programmes among asylum seekers tend to focus on chest radiography (CXR) for early diagnosis, whereas knowledge on sputum examination is limited. We evaluated active TB screening using CXR and sputum culture among asylum seekers arriving in Denmark. In addition, we assessed the coverage of a voluntary health assessment. METHODS Between 1 February 2017 and 31 March 2019, all newly arrived asylum seekers in Denmark ≥ 18 years from TB high-incidence countries or risk groups, who attended a voluntary general health assessment, were offered active TB screening with CXR and spot sputum examination. Sputum samples were examined by culture and smear microscopy. RESULTS Coverage of the general health assessment was 65.1%. Among 1,154 referred for active TB screening, 923 (80.0%) attended. Of these, 854 were screened by CXR and one case of active TB was identified equivalent to a yield of 0.12%. Sputum samples were collected from 758 and one M. tuberculosis culture-positive TB case (also identified by CXR) was identified, equivalent to a yield of 0.13%. No cases were found by sputum culture screening only. In addition, screening found three cases of malignant disease. CONCLUSION We suggest that TB screening should focus on asylum seekers from TB high-incidence countries. Furthermore, early health assessments should be of high priority to ensure migrant health.
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Affiliation(s)
- Kristina Langholz Kristensen
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark.,Department of Pulmonary- and Infectious Diseases, Nordsjaellands Hospital, Hilleroed, Denmark
| | - Marie Norredam
- Research Centre for Migration, Ethnicity and Health, University of Copenhagen, Copenhagen, Denmark.,Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital Hvidovre, Hvidovre, Denmark
| | - Sidse Graff Jensen
- Department of Internal Medicine, Section of Respiratory Diseases, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Niels Seersholm
- Department of Internal Medicine, Section of Respiratory Diseases, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Marie Louise Jørgensen
- Department of Pulmonary- and Infectious Diseases, Nordsjaellands Hospital, Hilleroed, Denmark
| | - Banoo Bakir Exsteen
- Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital Hvidovre, Hvidovre, Denmark.,Department of Internal Medicine, Infectious Disease Section, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Franziska Grundtvig Huber
- Department of Internal Medicine, Infectious Disease Section, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | | | - Troels Lillebaek
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark.,Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Pernille Ravn
- Department of Internal Medicine, Infectious Disease Section, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
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21
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Martró E, Ouaarab H, Saludes V, Buti M, Treviño B, Roade L, Egea-Cortés L, Reyes-Ureña J, Not A, Majó X, Colom J, Gómez I Prat J. Pilot hepatitis C micro-elimination strategy in Pakistani migrants in Catalonia through a community intervention. Liver Int 2022; 42:1751-1761. [PMID: 35635535 DOI: 10.1111/liv.15327] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 04/13/2022] [Accepted: 05/26/2022] [Indexed: 02/13/2023]
Abstract
BACKGROUND AND AIMS Pakistani migrants in Catalonia, Spain, could have high hepatitis C virus (HCV) prevalence. The aims of the HepClink study were (i) to implement and assess the quality of a micro-elimination strategy based on a community intervention and (ii) to obtain data from primary care (PC) registries as a baseline comparator. METHODS The community intervention targeted Pakistani adults and consisted of education, screening and simplified access to treatment. Quality indicators were calculated (effectiveness, impact and acceptability). The testing rate, the prevalence of HCV antibodies and HCV-RNA were compared with those observed in the Pakistani population accessing PC in the previous year. RESULTS A total of 505 participants were recruited through the community intervention (64.6% men, median 37 years) vs those accessing PC (N = 25 455, 70.9% men, median 38 years). Among study participants, 35.1% did not know about HCV and 9.7% had been previously tested. The testing rate in the community intervention was 99.4% vs 50.7% in PC. Prevalence was 4.6% vs 7.1% (p = .008) for HCV antibodies and 1.4% (3/6 new diagnoses) vs 2.4% (p = .183) for HCV-RNA. Among the six viremic patients, three began treatment within the intervention and two through the usual circuit and all completed the full course. CONCLUSIONS This novel community intervention was well accepted and effective at reaching a Pakistani migrant population with a low-level knowledge of HCV and largely not tested before. The observed prevalence and the high unawareness of their HCV status justify a targeted screening in this group both in the community and in PC.
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Affiliation(s)
- Elisa Martró
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona (Barcelona), Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Hakima Ouaarab
- Community & Public Health Team (ESPIC), Drassanes Vall d'Hebron Centre for International Health and Infectious Diseases, Barcelona, Spain
| | - Verónica Saludes
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona (Barcelona), Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Maria Buti
- Liver Unit, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,CIBER en Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Begoña Treviño
- Drassanes Vall d'Hebron Centre for International Health and Infectious Diseases, Barcelona, Spain
| | - Luisa Roade
- Liver Unit, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Laia Egea-Cortés
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona (Barcelona), Spain
| | - Juliana Reyes-Ureña
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona (Barcelona), Spain
| | - Anna Not
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona (Barcelona), Spain
| | - Xavier Majó
- Programa de prevenció, control i atenció al virus d'immunodeficiència humana (VIH), les infeccions de transmissió sexual (ITS) i les hepatitis víriques (HV), (PCAVIHV), Public Health Agency of Catalonia, Barcelona, Spain
| | - Joan Colom
- Programa de prevenció, control i atenció al virus d'immunodeficiència humana (VIH), les infeccions de transmissió sexual (ITS) i les hepatitis víriques (HV), (PCAVIHV), Public Health Agency of Catalonia, Barcelona, Spain
| | - Jordi Gómez I Prat
- Community & Public Health Team (ESPIC), Drassanes Vall d'Hebron Centre for International Health and Infectious Diseases, Barcelona, Spain
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22
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Nöstlinger C, Cosaert T, Landeghem EV, Vanhamel J, Jones G, Zenner D, Jacobi J, Noori T, Pharris A, Smith A, Hayes R, Val E, Waagensen E, Vovc E, Sehgal S, Laga M, Van Renterghem H. HIV among migrants in precarious circumstances in the EU and European Economic Area. Lancet HIV 2022; 9:e428-e437. [PMID: 35460600 DOI: 10.1016/s2352-3018(22)00032-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/22/2022] [Accepted: 01/28/2022] [Indexed: 06/14/2023]
Abstract
HIV epidemics in the EU and European Economic Area are increasingly diverse in transmission modes and groups affected. Substantial gaps in data exist on HIV burden and access to the HIV continuum of care among migrants living in this region, particularly individuals in precarious circumstances such as migrants with irregular status. Migrants have a higher HIV burden compared with the general population, and high rates of post-migration HIV acquisition. Migrants also face challenges in access to health and HIV services, with irregular migrants, foreign-born key populations such as men who have sex with men, sex workers, and people who inject drugs, and migrants from sub-Saharan Africa being most affected. Intersecting factors negatively affect their access to services along the full continuum of care, including prevention and psychosocial services. Ensuring equitable access to general health and HIV services, regardless of immigration status, and implementing interventions to reduce stigma and discrimination are crucial to ending AIDS by 2030.
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Affiliation(s)
| | - Theo Cosaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ella Van Landeghem
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jef Vanhamel
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Gary Jones
- Fast Track Implementation Department, UNAIDS, Geneva, Switzerland
| | - Dominik Zenner
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | | | - Teymur Noori
- Air-Borne, Blood-Borne and Sexually Transmitted Infections, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Anastasia Pharris
- Air-Borne, Blood-Borne and Sexually Transmitted Infections, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Alyna Smith
- Platform for International Cooperation on Undocumented Migrants (PICUM), Brussels, Belgium
| | - Rosalie Hayes
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Elena Val
- Migration Health Division, International Organisation of Migration (IOM), Brussels, Belgium
| | - Elisabeth Waagensen
- Migration and Health Programme, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Elena Vovc
- HIV/viral Hepatitis, STIs Unit of the Joint Infectious Diseases Program, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Sarita Sehgal
- Graduate School of Business, University of Cape Town, Cape Town, South Africa
| | - Marie Laga
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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23
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Vasylyev M, Skrzat-Klapaczyńska A, Bernardino JI, Săndulescu O, Gilles C, Libois A, Curran A, Spinner CD, Rowley D, Bickel M, Aichelburg MC, Nozza S, Wensing A, Barber TJ, Waters L, Jordans C, Bramer W, Lakatos B, Tovba L, Koval T, Kyrychenko T, Dumchev K, Buhiichyk V, Smyrnov P, Antoniak S, Antoniak S, Vasylyeva TI, Mazhnaya A, Kowalska J, Bhagani S, Rokx C. Unified European support framework to sustain the HIV cascade of care for people living with HIV including in displaced populations of war-struck Ukraine. THE LANCET HIV 2022; 9:e438-e448. [DOI: 10.1016/s2352-3018(22)00125-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 12/24/2022]
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24
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Margineanu I, Rustage K, Noori T, Zenner D, Greenaway C, Pareek M, Akkerman O, Hayward S, Friedland JS, Goletti D, Stienstra Y, Hargreaves S. Country-specific approaches to latent tuberculosis screening targeting migrants in EU/EEA* countries: A survey of national experts, September 2019 to February 2020. EURO SURVEILLANCE : BULLETIN EUROPEEN SUR LES MALADIES TRANSMISSIBLES = EUROPEAN COMMUNICABLE DISEASE BULLETIN 2022; 27. [PMID: 35332865 PMCID: PMC8950856 DOI: 10.2807/1560-7917.es.2022.27.12.2002070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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 countries use ‘country of origin’ as the main eligibility criteria. The countries took similar approaches to diagnosis and treatment but different approaches to follow-up. Six experts reported that drop-out rates in migrants were higher compared with non-migrant groups. Most of the experts (n = 22) called for a renewed focus on expanding efforts to screen for LTBI in migrants arriving in low-incidence countries. Conclusion We found a range of approaches to LTBI screening of migrants in the EU/EEA and Switzerland. Findings suggest a renewed focus is needed to expand and strengthen efforts to meaningfully include migrants in these programmes, in order to meet regional and global elimination targets for TB.
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Affiliation(s)
- Ioana Margineanu
- University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Kieran Rustage
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Teymur Noori
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | | | | | - Onno Akkerman
- University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Sally Hayward
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom.,The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Jon S Friedland
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Delia Goletti
- Translational Research Unit, Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases L. Spallanzani, Rome Italy
| | - Ymkje Stienstra
- University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Sally Hargreaves
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
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- The ESGITM/ESGMYC Study Groups are acknowledged at the end of the article
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25
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Migliori GB, Wu SJ, Matteelli A, Zenner D, Goletti D, Ahmedov S, Al-Abri S, Allen DM, Balcells ME, Garcia-Basteiro AL, Cambau E, Chaisson RE, Chee CBE, Dalcolmo MP, Denholm JT, Erkens C, Esposito S, Farnia P, Friedland JS, Graham S, Hamada Y, Harries AD, Kay AW, Kritski A, Manga S, Marais BJ, Menzies D, Ng D, Petrone L, Rendon A, Silva DR, Schaaf HS, Skrahina A, Sotgiu G, Thwaites G, Tiberi S, Tukvadze N, Zellweger JP, D Ambrosio L, Centis R, Ong CWM. Clinical standards for the diagnosis, treatment and prevention of TB infection. Int J Tuberc Lung Dis 2022; 26:190-205. [PMID: 35197159 PMCID: PMC8886963 DOI: 10.5588/ijtld.21.0753] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND: Tuberculosis (TB) preventive therapy (TPT) decreases the risk of developing TB disease and its associated morbidity and mortality. The aim of these clinical standards is to guide the assessment, management of TB infection (TBI) and implementation of TPT.METHODS: A panel of global experts in the field of TB care was identified; 41 participated in a Delphi process. A 5-point Likert scale was used to score the initial standards. After rounds of revision, the document was approved with 100% agreement.RESULTS: Eight clinical standards were defined: Standard 1, all individuals belonging to at-risk groups for TB should undergo testing for TBI; Standard 2, all individual candidates for TPT (including caregivers of children) should undergo a counselling/health education session; Standard 3, testing for TBI: timing and test of choice should be optimised; Standard 4, TB disease should be excluded prior to initiation of TPT; Standard 5, all candidates for TPT should undergo a set of baseline examinations; Standard 6, all individuals initiating TPT should receive one of the recommended regimens; Standard 7, all individuals who have started TPT should be monitored; Standard 8, a TBI screening and testing register should be kept to inform the cascade of care.CONCLUSION: This is the first consensus-based set of Clinical Standards for TBI. This document guides clinicians, programme managers and public health officers in planning and implementing adequate measures to assess and manage TBI.
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Affiliation(s)
- G B Migliori
- Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - S J Wu
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, Singapore City
| | - A Matteelli
- Division of Infectious and Tropical Diseases, Spedali Civili University Hospital, Brescia, Italy, WHO Collaborating Centre for TB/HIV Collaborative Activities and for TB Elimination Strategy, University of Brescia, Brescia, Italy
| | - D Zenner
- Centre for Global Public Health, Institute for Population Health Sciences, Queen Mary University, London, UK
| | - D Goletti
- Translational Research Unit, National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Rome, Italy
| | - S Ahmedov
- USAID, Bureau for Global Health, TB Division, Washington, DC, USA
| | - S Al-Abri
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - D M Allen
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, Singapore City, Infectious Disease Translational Research Programme, Department of Medicine, National University of Singapore, Yong Loo Lin School of Medicine, Singapore City
| | - M E Balcells
- Department of Infectious Diseases, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - A L Garcia-Basteiro
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, ISGlobal, Barcelona Centre for International Health Research, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - E Cambau
- IAME UMR1137, INSERM, University of Paris, F-75018 Paris; AP-HP-Bichat Hospital, Associate laboratory of National Reference Center for Mycobacteria and Antimycobacterial Resistance, Paris, France
| | - R E Chaisson
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C B E Chee
- Tuberculosis Control Unit, Tan Tock Seng Hospital, Singapore, Singapore
| | - M P Dalcolmo
- Helio Fraga Reference Center, Oswaldo Cruz Foundation Ministry of Health, Rio de Janeiro, Brazil
| | - J T Denholm
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, VIC, Australia, Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
| | - C Erkens
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - S Esposito
- Paediatric Clinic, Pietro Barilla Children´s Hospital, University of Parma, Parma, Italy
| | - P Farnia
- Mycobacteriology Research Center (MRC), National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - J S Friedland
- Institute for Infection and Immunity, St George´s, University of London, London, UK
| | - S Graham
- Department of Paediatrics, Center for International Child Health, University of Melbourne, Melbourne, VIC, Australia, Murdoch Children´s Research Institute, Royal Children´s Hospital, Melbourne, Australia
| | - Y Hamada
- Institute for Global Health, University College London, London, UK
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - A W Kay
- The Global Tuberculosis Program, Texas Children´s Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - A Kritski
- Academic Tuberculosis Program Center, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - S Manga
- Operational Center, Medecins Sans Frontieres (MSF), Paris, France
| | - B J Marais
- Department of Infectious Diseases and Microbiology, The Children´s Hospital at Westmead, Westmead, NSW, Australia, The University of Sydney Institute for Infectious Diseases, Sydney, NSW, Australia
| | - D Menzies
- Montréal Chest Institute, Montréal, QC, Canada, Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montréal, QC, Canada, McGill International Tuberculosis Centre, Montréal, QC, Canada
| | - D Ng
- Infectious Diseases, National Centre for Infectious Diseases, Singapore
| | - L Petrone
- Translational Research Unit, National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Rome, Italy
| | - A Rendon
- Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias CIPTIR, University Hospital of Monterrey UANL (Universidad Autonoma de Nuevo Leon), Monterrey, Mexico
| | - D R Silva
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A Skrahina
- Republican Research and Practical Center for Pulmonology and Tuberculosis, Minsk, Belarus
| | - G Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - G Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - S Tiberi
- Department of Infection, Royal London Hospital, Barts Health NHS Trust, London, UK, Blizard Institute, Queen Mary University of London, London, UK
| | - N Tukvadze
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - J-P Zellweger
- TB Competence Center, Swiss Lung Association, Berne, Switzerland
| | - L D Ambrosio
- Public Health Consulting Group, Lugano, Switzerland
| | - R Centis
- Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - C W M Ong
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, Singapore City, Infectious Disease Translational Research Programme, Department of Medicine, National University of Singapore, Yong Loo Lin School of Medicine, Singapore City, National University of Singapore Institute for Health Innovation & Technology (iHealthtech), Singapore, Singapore
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26
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Against All Odds? Addiction History Associated with Better Viral Hepatitis Care: A Dutch Nationwide Claims Data Study. J Clin Med 2022; 11:jcm11041146. [PMID: 35207419 PMCID: PMC8878485 DOI: 10.3390/jcm11041146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 02/01/2023] Open
Abstract
The elimination of viral hepatitis in target populations is crucial in reaching WHO viral hepatitis elimination goals. Several barriers for the treatment of viral hepatitis in people with addictive disorders have been identified, yet nationwide data on hepatitis healthcare utilization (HCU) in these patients are limited. We investigated whether a history of addictive disorder is associated with suboptimal hepatitis HCU, indicating failure to receive diagnostic care or treatment. We identified all newly referred viral hepatitis patients in the Netherlands between 2014 and 2019 by query of the Dutch national hospital claims database. Each patient’s first year of HBV or HCV care activities was collected and clustered in two categories, ‘optimal’ or ‘suboptimal’ hepatitis HCU. Optimal HCU includes antiviral therapy. We tested the association between addiction history and HCU, adjusted for sex, age, migrant status, and comorbidity. In secondary analyses, we explored additional factors affecting hepatitis HCU. We included 10,513 incident HBV and HCV patients, with 13% having an addiction history. Only 47% of all patients achieved optimal hepatitis HCU. Addiction history was associated with less suboptimal HCU (adjusted OR = 0.73, 95% CI = 0.64–0.82). Migration background was associated with suboptimal HCU (OR = 1.62, 95% CI = 1.50–1.76). This study shows that addiction history is associated with higher viral hepatitis HCU; thus, this population performs better compared to non-addicted patients. However, less than 50% of all patients received optimal hepatitis care. This study highlights the need to improve hepatitis HCU in all patients, with a focus on migrant populations. Linkage to care in the addicted patients is not studied here and may be a remaining obstacle to be studied and improved to reach WHO viral hepatitis elimination goals.
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27
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Cinardo P, Farrant O, Gunn K, Ward A, Eisen S, Longley N. Screening for neglected tropical diseases and other infections in refugee and asylum-seeker populations in the United Kingdom. Ther Adv Infect Dis 2022; 9:20499361221116680. [PMID: 35958977 PMCID: PMC9358592 DOI: 10.1177/20499361221116680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/13/2022] [Indexed: 11/24/2022] Open
Abstract
Asylum-seekers and refugees have an increased burden of infections compared with the general population. This has been widely recognised by countries welcoming those fleeing conflict and persecution; however, there are no screening standardised guidelines and regulatory processes. Identification of certain neglected tropical diseases (NTDs) and other infections is important for the health and well-being of the individual in addition to public health and biosecurity. In the United Kingdom, screening for infections at port of entry or after arrival is not mandatory. Those on refugee resettlement programmes will have infection screening as part of their pre-entry health assessment, but no such system exists for those claiming asylum in the United Kingdom. In this article, we have reviewed published, peer-reviewed articles looking at the approaches to screening for NTDs and infectious diseases in the United Kingdom. In addition to this, we have reviewed the literature looking at the acceptability, barriers and facilitators of these screening practices. We found that there is a heterogeneous approach to screening practices in the United Kingdom and a paucity of data to support a single ‘best practice’ approach. Based on our findings, we have made recommendations and consideration for NTD screening strategies and highlighted important areas for future research.
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Affiliation(s)
- Paola Cinardo
- Clinical Research Fellow, Acute Medicine, University College Hospital, 235 Euston Road, London, NW1 2BU, London, UK
| | - Olivia Farrant
- Infectious Diseases, Hospital for Tropical Diseases, London, UK; Acute Medicine, University College Hospital, London, UK
| | - Kimberlee Gunn
- Division of Infection and Immunity, University College Hospital, London, UK
| | - Allison Ward
- Children's & Adolescent Services, Royal Free London NHS Foundation Trust, London, UK
| | - Sarah Eisen
- Children and Young People's Services, University College Hospital, London, UK
| | - Nicky Longley
- Infectious Diseases and Travel Medicine, Hospital for Tropical Diseases, London, UK
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28
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Policies and initiatives/programs that promote health and self-care in asylum seekers living in high income countries: a narrative review. INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTHCARE 2021. [DOI: 10.1108/ijhrh-09-2021-0165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to identify health-care entitlements that exist for asylum seekers with chronic non-communicable disease (CNCD) that promote their health and self-care, and to explore health policies, initiatives and programmes with the potential to foster self-care in this populace.
Design/methodology/approach
Narrative review of literature conducted by searching EMBASE, CINAHL, WEB OF SCIENCE and PSYCINFO databases for articles published from 2010 to 2021. Included articles focussed on policies, programmes or initiatives with the potential to promote health in adult asylum seekers residing in high-income countries. Studies inclusive of other migrant groups such as undocumented migrants and those with mental health conditions were excluded. Eleven studies fitting the inclusion criteria were assessed against the study objectives.
Findings
Free access to health-care services and pharmaceutical products, free access to food banks and supermarket model food banks, English and cooking lessons, community integration training sessions and culturally competent health-care workers were found to promote health and self-care. There is little research on self-care and health promotion in adult asylum seekers with CNCD. CNCDs represent high burden of disease in asylum seekers but have a low priority in reported research.
Originality/value
This narrative review is the first to explicitly focus on asylum seekers in high-income countries with CNCD, excluding mental health conditions, and to explore initiatives, programmes and policies that enhance health promotion to facilitate self-care in this populace.
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29
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D’Ambrosio L, Centis R, Dobler CC, Tiberi S, Matteelli A, Denholm J, Zenner D, Al-Abri S, Alyaquobi F, Arbex MA, Belilovskiy E, Blanc FX, Borisov S, Carvalho ACC, Chakaya JM, Cocco N, Codecasa LR, Dalcolmo MP, Dheda K, Dinh-Xuan AT, Esposito SR, García-García JM, Li Y, Manga S, Marchese V, Muñoz Torrico M, Pontali E, Rendon A, Rossato Silva D, Singla R, Solovic I, Sotgiu G, van den Boom M, Nhung NV, Zellweger JP, Migliori GB. Screening for Tuberculosis in Migrants: A Survey by the Global Tuberculosis Network. Antibiotics (Basel) 2021; 10:1355. [PMID: 34827293 PMCID: PMC8615134 DOI: 10.3390/antibiotics10111355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 01/02/2023] Open
Abstract
Tuberculosis (TB) does not respect borders, and migration confounds global TB control and elimination. Systematic screening of immigrants from TB high burden settings and-to a lesser degree TB infection (TBI)-is recommended in most countries with a low incidence of TB. The aim of the study was to evaluate the views of a diverse group of international health professionals on TB management among migrants. Participants expressed their level of agreement using a six-point Likert scale with different statements in an online survey available in English, French, Mandarin, Spanish, Portuguese and Russian. The survey consisted of eight sections, covering TB and TBI screening and treatment in migrants. A total of 1055 respondents from 80 countries and territories participated between November 2019 and April 2020. The largest professional groups were pulmonologists (16.8%), other clinicians (30.4%), and nurses (11.8%). Participants generally supported infection control and TB surveillance established practices (administrative interventions, personal protection, etc.), while they disagreed on how to diagnose and manage both TB and TBI, particularly on which TBI regimens to use and when patients should be hospitalised. The results of this first knowledge, attitude and practice study on TB screening and treatment in migrants will inform public health policy and educational resources.
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Affiliation(s)
- Lia D’Ambrosio
- Public Health Consulting Group, 6900 Lugano, Switzerland;
| | - Rosella Centis
- Servizio di Epidemiologia, Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, 21049 Tradate, Italy;
| | - Claudia C. Dobler
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2042, Australia;
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, NSW 2107, Australia
| | - Simon Tiberi
- Department of Infection, Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK;
- Blizard Institute, Queen Mary University of London, London E1 2AT, UK
| | - Alberto Matteelli
- Division of Infectious and Tropical Diseases, Spedali Civili University Hospital, 25123 Brescia, Italy; (A.M.); (V.M.)
- WHO Collaborating Centre for TB/HIV Collaborative Activities and for TB Elimination Strategy, University of Brescia, 25123 Brescia, Italy
| | - Justin Denholm
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, VIC 3000, Australia;
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC 3010, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC 3050, Australia
| | - Dominik Zenner
- Centre for Global Public Health, Institute for Population Health Sciences, Queen Mary University, London E1 2AB, UK;
| | - Seif Al-Abri
- Directorate General of Disease Surveillance and Control, Ministry of Health, Muscat 100, Oman; (S.A.-A.); (F.A.)
| | - Fatma Alyaquobi
- Directorate General of Disease Surveillance and Control, Ministry of Health, Muscat 100, Oman; (S.A.-A.); (F.A.)
| | - Marcos Abdo Arbex
- Nestor Goulart Reis Hospital, Health Secretary São Paulo State, Sao Paulo 14801-320, Brazil;
- Faculdade de Medicina, Universidade de Araraquara, Sao Paulo 14801-320, Brazil
| | - Evgeny Belilovskiy
- Moscow Research and Clinical Center for Tuberculosis Control, 107014 Moscow, Russia; (E.B.); (S.B.)
| | - François-Xavier Blanc
- Service de Pneumologie, Centre Hospitalier Universitaire, L’institut du Thorax, F-44093 Nantes, France;
| | - Sergey Borisov
- Moscow Research and Clinical Center for Tuberculosis Control, 107014 Moscow, Russia; (E.B.); (S.B.)
| | - Anna Cristina C. Carvalho
- Laboratório de Inovações em Terapias, Ensino e Bioprodutos (LITEB), Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, Brazil;
| | - Jeremiah Muhwa Chakaya
- Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi P.O. Box 43844-00100, Kenya;
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Nicola Cocco
- ASST Santi Paolo e Carlo—Medicina Penitenziaria, 21100 Milan, Italy;
| | - Luigi Ruffo Codecasa
- TB Reference Centre, Villa Marelli Institute, Niguarda Hospital, 20159 Milan, Italy;
| | - Margareth Pretti Dalcolmo
- Reference Center Hélio Fraga, Fundação Oswaldo Cruz (Fiocruz), Ministry of Health, Rio de Janeiro 21040-360, Brazil;
| | - Keertan Dheda
- South African MRC Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town 7701, South Africa;
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute, University of Cape Town, Cape Town 7701, South Africa
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London 400706, UK
| | - Anh Tuan Dinh-Xuan
- Respiratory Physiology Unit, Department of Respiratory Medicine, Cochin Hospital, Université de Paris, 75014 Paris, France;
| | - Susanna R. Esposito
- Paediatric Clinic, Department of Medicine and Surgery, University Hospital, University of Parma, 43126 Parma, Italy;
| | | | - Yang Li
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai 200040, China;
| | - Selene Manga
- Ministry of Health, Direccion General de Gestion de Riesgos en y Desastres en Salud, Lima 15072, Peru;
| | - Valentina Marchese
- Division of Infectious and Tropical Diseases, Spedali Civili University Hospital, 25123 Brescia, Italy; (A.M.); (V.M.)
- WHO Collaborating Centre for TB/HIV Collaborative Activities and for TB Elimination Strategy, University of Brescia, 25123 Brescia, Italy
| | - Marcela Muñoz Torrico
- Clínica de Tuberculosis, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City 14080, Mexico;
| | - Emanuele Pontali
- Department of Infectious Diseases, Galliera Hospital, 16128 Genoa, Italy;
| | - Adrián Rendon
- Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias CIPTIR, University Hospital of Monterrey UANL (Universidad Autonoma de Nuevo Leon), Monterrey 64000, Mexico;
| | - Denise Rossato Silva
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-903, Brazil;
| | - Rupak Singla
- Department of TB & Respiratory Diseases, National Institute of TB & Respiratory Diseases, Sri Aurobindo Marg, New Delhi 110030, India;
| | - Ivan Solovic
- National Institute for TB, Vysne Hagy, Catholic University, 05984 Ruzomberok, Slovakia;
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Martin van den Boom
- WHO Regional Office for the Eastern Mediterranean Region, Cairo 11571, Egypt;
| | | | | | - Giovanni Battista Migliori
- Servizio di Epidemiologia, Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, 21049 Tradate, Italy;
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Cortier M, de La Porte C, Papot E, Goudjo A, Guenneau L, Riou F, Cervantes-Gonzalez M, Prioux M, Yazdanpanah Y, Galy A. Health status and healthcare trajectory of vulnerable asylum seekers hosted in a French Reception Center. Travel Med Infect Dis 2021; 46:102180. [PMID: 34699955 DOI: 10.1016/j.tmaid.2021.102180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 08/19/2021] [Accepted: 10/18/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Europe lacks studies related to asylum-seekers' health. METHODS We described the health status, healthcare and follow-up of men seeking asylum, accommodated in a primary reception center in Paris (CPA). This observational study included volunteer patients presenting for care at the CPA primary care unit (PCU) from January to March 2018. They could be referred to on-site GPs and psychiatrists or to surrounding healthcare facilities. After their asylum application, patients were transferred to other French accommodation centers. PCU healthcare professionals could make referrals for close medical reassessments after transfer. RESULTS The 728 included men came mostly from Central Asia or Middle East (65%) and Africa (34%). Seventy percent reported violence during migration. Seventy-five percent (547/728) were referred to on-site GPs, 20% to psychiatrists. During patients' stay at CPA, 67% (144/214) of referrals to surrounding healthcare facilities led to performed consultations. Seven percent of all the included patients (49/728) were referred for frequent communicable infectious diseases screening. Final diagnoses (n = 1108) included 31% infectious diseases and 7% psychiatric disorders. When post-transfer accommodation centers could be reached, 69% (33/48) of the medical referrals had led to a scheduled appointment. CONCLUSIONS The healthcare trajectory at CPA could benefit from optimization of infectious and psychiatric screenings, and improved coordination of care and follow-up.
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Affiliation(s)
- Marie Cortier
- Assistance Publique - Hôpitaux de Paris, Nord - Université de Paris, Bichat - Claude-Bernard University Hospital, Department of Infectious and Tropical Diseases, 46 rue Henri Huchard, 75018, Paris, France
| | - Clémentine de La Porte
- Assistance Publique - Hôpitaux de Paris, Nord - Université de Paris, Bichat - Claude-Bernard University Hospital, Department of Infectious and Tropical Diseases, 46 rue Henri Huchard, 75018, Paris, France.
| | - Emmanuelle Papot
- Assistance Publique - Hôpitaux de Paris, Nord - Université de Paris, Bichat - Claude-Bernard University Hospital, Department of Infectious and Tropical Diseases, 46 rue Henri Huchard, 75018, Paris, France; Université de Paris, IAME, INSERM, UMR 1137, 16 rue Henri Huchard, 75018, Paris, France
| | - Abdon Goudjo
- Samusocial de Paris, 35 avenue Courteline, 75012, Paris, France
| | - Laure Guenneau
- Samusocial de Paris, 35 avenue Courteline, 75012, Paris, France
| | - Françoise Riou
- Samusocial de Paris, 35 avenue Courteline, 75012, Paris, France
| | - Minerva Cervantes-Gonzalez
- Assistance Publique - Hôpitaux de Paris, Nord - Université de Paris, Bichat - Claude-Bernard University Hospital, Department of Infectious and Tropical Diseases, 46 rue Henri Huchard, 75018, Paris, France; Université de Paris, IAME, INSERM, UMR 1137, 16 rue Henri Huchard, 75018, Paris, France
| | - Maëlle Prioux
- Samusocial de Paris, 35 avenue Courteline, 75012, Paris, France
| | - Yazdan Yazdanpanah
- Assistance Publique - Hôpitaux de Paris, Nord - Université de Paris, Bichat - Claude-Bernard University Hospital, Department of Infectious and Tropical Diseases, 46 rue Henri Huchard, 75018, Paris, France; Université de Paris, IAME, INSERM, UMR 1137, 16 rue Henri Huchard, 75018, Paris, France
| | - Adrien Galy
- Assistance Publique - Hôpitaux de Paris, Nord - Université de Paris, Bichat - Claude-Bernard University Hospital, Department of Infectious and Tropical Diseases, 46 rue Henri Huchard, 75018, Paris, France
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Low-Wage Agricultural Migrant Workers in Apulian Ghettos, Italy: General Health Conditions Assessment and HIV Screening. Trop Med Infect Dis 2021; 6:tropicalmed6040184. [PMID: 34698299 PMCID: PMC8544678 DOI: 10.3390/tropicalmed6040184] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/07/2021] [Accepted: 10/12/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Approximately 500,000 migrants work in the agricultural sector in Italy. Many of them live in shantytowns, wrongly called “ghettos”, far away from city centers, with no water, proper hygienic conditions or health services. The aim of this study is to assess general health conditions and HIV prevalence by giving hygienic and sanitary sustenance. Methods: Between June 2019 and February 2020, we performed a screening campaign for HIV–diabetes–hypertension, involving migrants living in three Apulian establishments: ghetto Pista, “Sankara House” and “Arena House”. Results: Overall, 321 migrants were enrolled in the study. In the medical screening, one HIV test resulted positive. Hypertension was found in 12% of the migrants visited, diabetes in 2% and TB symptoms in 17%. Among others symptoms explored, muscle and joint pain/fatigue resulted in being the most frequent, and was reported by 34% of the migrants, followed by cough (10%). Significant predictors of muscle and joint pain/fatigue were: low BMI values (OR = 1.32; 95% CI 1.19–1.99), the absence of education (OR = 1.85; 95% CI 1.02–2.95), being employed with a regular contract (OR = 2.64; 95% CI 2.39–2.83) and living in the ghettos since >12 months (OR = 1.74; 95% CI 1.24–2.21). Conclusions: Our experience suggests that, in this population, the health condition is mainly linked to the specific working activities in the agricultural fields, as well as to the hygienic and living conditions, and that all of this is due to the lack of social protection in their life and job.
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Voluntary HIV and Viral Hepatitis Testing in Newly Arrived Migrant Men in a First Reception Center in the North of Paris—a Qualitative Study on the Perception and Forms of Participation. JOURNAL OF INTERNATIONAL MIGRATION AND INTEGRATION 2021. [DOI: 10.1007/s12134-021-00897-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lambert JF, Stete K, Balmford J, Bockey A, Kern W, Rieg S, Boeker M, Lange B. Reducing burden from respiratory infections in refugees and immigrants: a systematic review of interventions in OECD, EU, EEA and EU-applicant countries. BMC Infect Dis 2021; 21:872. [PMID: 34445957 PMCID: PMC8390210 DOI: 10.1186/s12879-021-06474-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/26/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Respiratory diseases are a major reason for refugees and other immigrants seeking health care in countries of arrival. The burden of respiratory diseases in refugees is exacerbated by sometimes poor living conditions characterised by crowding in mass accommodations and basic living portals. The lack of synthesised evidence and guideline-relevant information to reduce morbidity and mortality from respiratory infections endangers this population. METHODS A systematic review of all controlled and observational studies assessing interventions targeting the treatment, diagnosis and management of respiratory infections in refugees and immigrants in OECD, EU, EEA and EU-applicant countries published between 2000 and 2019 in MEDLINE, CINAHL, PSYNDEX and the Web of Science. RESULTS Nine of 5779 identified unique records met our eligibility criteria. Seven studies reported an increase in vaccine coverage from 2 to 52% after educational multilingual interventions for respiratory-related childhood diseases (4 studies) and for influenza (5 studies). There was limited evidence in one study that hand sanitiser reduced rates of upper respiratory infections and when provided together with face masks also the rates of influenza-like-illness in a hard to reach migrant neighbourhood. In outbreak situations of vaccine-preventable diseases, secondary cases and outbreak hazards were reduced by general vaccination strategies early after arrival but not by serological testing after exposure (1 study). We identified evidence gaps regarding interventions assessing housing standards, reducing burden of bacterial pneumonia and implementation of operational standards in refugee care and reception centres. CONCLUSIONS Multilingual health literacy interventions should be considered to increase uptake of vaccinations in refugees and immigrants. Immediate vaccinations upon arrival at refugee housings may reduce secondary infections and outbreaks. Well-designed controlled studies on housing and operational standards in refugee and immigrant populations early after arrival as well as adequate ways to gain informed consent for early vaccinations in mass housings is required to inform guidelines.
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Affiliation(s)
- Jan-Frederic Lambert
- Division of Infectious Diseases, Department of Medicine II, Medical Center and Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg im Breisgau, DE, Germany.
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg im Breisgau, Germany.
| | - Katarina Stete
- Division of Infectious Diseases, Department of Medicine II, Medical Center and Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg im Breisgau, DE, Germany
| | - James Balmford
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Annabelle Bockey
- Division of Infectious Diseases, Department of Medicine II, Medical Center and Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg im Breisgau, DE, Germany
| | - Winfried Kern
- Division of Infectious Diseases, Department of Medicine II, Medical Center and Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg im Breisgau, DE, Germany
| | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, Medical Center and Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg im Breisgau, DE, Germany
| | - Martin Boeker
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Berit Lange
- Division of Infectious Diseases, Department of Medicine II, Medical Center and Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg im Breisgau, DE, Germany
- Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr.7, 38124, Braunschweig, DE, Germany
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Eiset AH, Stensvold CR, Fuursted K, Nielsen HV, Wejse C. High prevalence of methicillin-resistant Staphylococcus aureus, Giardia, and Blastocystis in asymptomatic Syrian asylum seekers in Denmark during 2016 through 2018. J Migr Health 2021; 1-2:100016. [PMID: 34405169 PMCID: PMC8352168 DOI: 10.1016/j.jmh.2020.100016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 11/30/2022] Open
Abstract
High prevalence of intestinal parasite colonisation; all were asymptomatic. High prevalence of MRSA; low prevalence of ESBL and CPO. Recommend attention to antimicrobial resistance when attending to Syrian refugees. Recommend no routine screening for parasites in asymptomatic adult Syrian refugees.
Introduction Concerns have been raised regarding the emergence of antimicrobial-resistance and parasitic infections in the European refugee population. Here, we estimated the prevalence of intestinal parasites and selected antimicrobial-resistant bacteria in newly arrived asylum seekers in Denmark. Materials and methods Using a cross-sectional one-stage cluster sample design, adult Syrian asylum seekers were included upon arrival in Denmark. Faecal samples were collected and tested for ova and parasites, extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) and carbapenemase-producing organisms (CPO). Throat swabs were collected and analysed for methicillin-resistant Staphylococcus aureus (MRSA) and Corynebacterium diphtheriae. Results We invited 121 eligible individuals (20% of the source population) from six different asylum centres to participate, of whom 113 agreed. Throat swabs and faecal samples were received from 104 and 48 participants, respectively. Seven individuals did not provide enough material for the entire panel of faecal analyses. Three individuals (7.3%, 95%CI: 2.5–19.4%) were colonised with Giardia intestinalis and 28 (68.3%, 95%CI: 53.0–80.4%) with Blastocystis sp. (subtypes 1 [n = 5], 2 [n = 9] and 3 [n = 14]). Seven individuals (6.7%, 95%CI: 3.3–13.3%) were colonised with MRSA and one with ESBL-E. None had CPO or Corynebacterium diphtheriae and none reported any gastro-intestinal symptoms. Discussion Even with the most conservative estimates, the prevalence of Giardia intestinalis, Blastocystis sp. and MRSA was high in this asymptomatic refugee population. Conclusions We highlight the importance of raised awareness of antimicrobial-resistant bacteria when attending to newly arrived Syrian refugees. Meanwhile, our data suggest that routine screening for intestinal parasites in this population is of limited clinical relevance.
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Affiliation(s)
- Andreas Halgreen Eiset
- Center for Global Health (GloHAU), Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - Christen Rune Stensvold
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark
| | - Kurt Fuursted
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark
| | - Henrik Vedel Nielsen
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark
| | - Christian Wejse
- Center for Global Health (GloHAU), Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
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Hvass AMF, Norredam M, Sodemann M, Wejse C. Is there a need of health assessments for resettling refugees? A cross-sectional study of 1431 refugees who arrived in Denmark between 2014 and 2018. J Migr Health 2021; 3:100044. [PMID: 34405189 PMCID: PMC8352093 DOI: 10.1016/j.jmh.2021.100044] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/03/2020] [Accepted: 04/10/2021] [Indexed: 11/18/2022] Open
Abstract
Health assessments of newly arrived refugees detected health problems in 64%. Symptoms of PTSD were mentioned in a third of all health assessments. Vitamin D-deficiency was seen in 32% and latent tuberculosis in 15%. 88% of all newly arrived refugees in Aarhus accepted the offer of a health assessment.
Background Refugees have increased health risks due to factors related to their country of origin, the migration itself and the receiving country. Based on systematic general health assessments of newly arrived refugees, we aimed to study the characteristics with regard to background, migration and health needs. Methods All refugees (children/adolescents and adults) arriving in Aarhus, Denmark from 1 January 2014 to 1 November 2018 were offered a general health assessment by a doctor including: medical history, a physical examination and blood samples. Results A cohort of 1431 (of 1618 invited, (88.4%) participants accepted the health assessment. The most commonly found health conditions in children were vitamin D deficiency (28.3%), elevated serum-IgE (34%) and lack of immunity against vaccine-preventable diseases (measles 20.1%, polio 3.9%). In adults, vitamin D deficiency (34.6%), IgE elevation (30%), latent tuberculosis (20.3%) and symptoms of PTSD (15.9%) were most prevalent. We found participants from Southern Asia (Iran, Afghanistan and Pakistan) to be overrepresented with regard to vitamin D deficiency, vitamin B12 deficiency and symptoms of PTSD. Furthermore, we found that origin in Africa was associated with latent tuberculosis. In total, 63.8% of examined refugees had one or more health problems requiring further testing, treatment or follow-up. Conclusions A comprehensive health assessment among recently arrived refugees showed multiple health issues to address, and demonstrates the need of systematic health assessments for resettling refugees.
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Affiliation(s)
- Anne Mette F Hvass
- Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Aarhus, Denmark.,Department of Social Medicine, Aarhus Municipality, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Denmark
| | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353, Copenhagen K, Denmark.,Section for Immigrant Medicine, Department of Infectious Diseases, Hvidovre University Hospital, Denmark
| | - Morten Sodemann
- Migrant Health Clinic, Department of Infectious Diseases, Odense University Hospital
| | - Christian Wejse
- Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Denmark.,Department of Public Health, Center for Global Health, Aarhus University, Bartolins Alle 4, 8000 Aarhus C, Denmark
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Rustage K, Lobe J, Hayward SE, Kristensen KL, Margineanu I, Stienstra Y, Goletti D, Zenner D, Noori T, Pareek M, Greenaway C, Friedland JS, Nellums LB, Hargreaves S. Initiation and completion of treatment for latent tuberculosis infection in migrants globally: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2021; 21:1701-1712. [PMID: 34363771 PMCID: PMC8612939 DOI: 10.1016/s1473-3099(21)00052-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/06/2021] [Accepted: 01/15/2021] [Indexed: 01/01/2023]
Abstract
Background Latent tuberculosis infection (LTBI) is one of the most prevalent infections globally and can lead to the development of active tuberculosis disease. In many low-burden countries, LTBI is concentrated within migrant populations often because of a higher disease burden in the migrant's country of origin. National programmes consequently focus on screening and treating LTBI in migrants to prevent future tuberculosis cases; however, how effective these programmes are is unclear. We aimed to assess LTBI treatment initiation and outcomes among migrants, and the factors that influence both. Methods For this systematic review and meta-analysis, we searched Embase, MEDLINE, and Global Health, and manually searched grey literature from Jan 1, 2000, to April 21, 2020. We included primary research articles reporting on LTBI treatment initiation or completion, or both, in migrants and excluded articles in which data were not stratified by migrant status, or in which the data were related to outcomes before 2000. There were no geographical or language restrictions. All included studies were quality appraised using recognised tools depending on their design, and we assessed the heterogeneity of analyses using I2. We extracted data on the numbers of migrants initiating and completing treatment. Our primary outcomes were LTBI treatment initiation and completion in migrants (defined as foreign-born). We used random-effects meta-regression to examine the influence of factors related to these outcomes. The study is registered with PROSPERO (CRD42019140338). Findings 2199 publications were retrieved screened, after which 39 publications from 13 mostly high-income, low-burden countries were included in our analyses, with treatment initiation and completion data reported for 31 598 migrants positive for LTBI, with not all articles reporting the full pathway from initiation to completion. The pooled estimate for the true proportion of migrants testing positive who initiated treatment was 69% (95% CI 51–84; I2= 99·62%; 4409 of 8764). The pooled estimate for the true proportion of migrants on treatment in datasets, who subsequently completed it was 74% (95% CI = 66–81; I2= 99·19%; 15 516 of 25 629). Where data were provided for the entire treatment pathway, the pooled estimate for the true proportion of migrants who initiated and completed treatment after a positive test was only 52% (95% CI 40–64; I2= 98·90%; 3289 of 6652). Meta-regression showed that LTBI programmes are improving, with more recent reported data (2010–20) associated with better rates of treatment initiation and completion, with multiple complex factors affecting treatment outcomes in migrants. Interpretation Although our analysis highlights that LTBI treatment initiation and completion in migrants has improved considerably from 2010–20, there is still room for improvement, with drop out reported along the entire treatment pathway. The delivery of these screening and treatment programmes will require further strengthening if the targets to eradicate tuberculosis in low-incidence countries are to be met, with greater focus needed on engaging migrants more effectively in the clinic and understanding the diverse and unique barriers and facilitators to migrants initiating and completing treatment. Funding European Society of Clinical Microbiology and Infectious Diseases, the Rosetrees Trust, the National Institute for Health Research, and the Academy of Medical Sciences.
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Affiliation(s)
- Kieran Rustage
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Jessica Lobe
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Sally E Hayward
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK; Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Kristina L Kristensen
- Research Centre for Migration, Ethnicity and Health, University of Copenhagen, Copenhagen, Denmark; International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - Ioana Margineanu
- Department of Internal Medicineand Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ymkje Stienstra
- Research Centre for Migration, Ethnicity and Health, University of Copenhagen, Copenhagen, Denmark
| | - Delia Goletti
- Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Dominik Zenner
- Institute for Population Health Sciences, Queen Mary University of London, London, UK
| | - Teymur Noori
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Christina Greenaway
- Division of Infectious Diseases, Jewish General Hospital, McGill University, Montreal, QC, Canada; Center for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Jon S Friedland
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Laura B Nellums
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Sally Hargreaves
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK.
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Differences in Incidence of Acute Viral Hepatitis between Foreigners and Autochthonous Population in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157944. [PMID: 34360239 PMCID: PMC8345609 DOI: 10.3390/ijerph18157944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/21/2021] [Accepted: 07/23/2021] [Indexed: 01/05/2023]
Abstract
Background: In European countries, the prevalence of HBV and HCV in refugees and migrants tends to reflect the prevalence in their countries of origin. The aim of this study is to analyse acute viral hepatitis cases diagnosed in Italy among foreign citizens and to compare incidence rates in foreigners and Italians. Methods: We analysed the cases of each viral hepatitis type among foreigners. Standardised incidence rates were compared between natives and foreigners. Results: Between 2004 and 2019, 15,872 cases of acute viral hepatitis were notified by 10 Italian regions, 14.8% among foreign citizens. Until 2012, the percentage increased gradually, while a fluctuating trend set in from 2013 onwards; in 2019, 23.9% of cases were foreigners. Data from the SEIEVA surveillance show higher standardised incidence rates of hepatitis A and B among foreign citizens; no significant difference emerged between Italians and foreigners in terms of their hepatitis C incidence. Conclusions: foreign citizens have an increased incidence of hepatitis A and B. Regarding hepatitis A, vaccination is strongly recommended to foreigners travelling to their countries of origin. Screening tests for hepatitis B and C infection should be offered to newly arrived migrants from high prevalence countries, or having specific risk factors.
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Elisabeth M, Maneesh PS, Katarina SF, Slobodan Z, Michael S. Antimicrobial Resistance & Migrants in Sweden: Poor Living Conditions Enforced by Migration Control Policies as a Risk Factor for Optimal Public Health Management. Front Public Health 2021; 9:642983. [PMID: 34277534 PMCID: PMC8281056 DOI: 10.3389/fpubh.2021.642983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 06/11/2021] [Indexed: 11/13/2022] Open
Abstract
Infectious diseases exacerbated by Antimicrobial Resistance (AMR) are of increasing concern in Sweden, with multi-drug resistant strains associated with new resistance mechanisms that are emerging and spreading worldwide. Existing research has identified that sub-optimal living conditions and poor access to healthcare are significant factors in the spread and incubation of AMR strains. The article considers this linkage and the effort to control the spread of AMR in relation to migrants, highlighting deficiencies in public policy where such individuals are often increasingly exposed to those conditions that exacerbate AMR. In many of the richest countries, those conditions are not accidental, but often direct goals of policies designed with the goal of deterring migrants from staying within host countries. Without engaging with the politics around migration control, the article points to urgent need for more holistic assessment of all public policies that may, however unintentionally, undermine AMR control through worsening living conditions for vulnerable groups. The consequences of prioritizing policies meant to deliberately worsen the living conditions of migrants over avoiding those conditions that accelerate AMR spread, are today made ever apparent where new AMR strains have the potential to dwarf the societal effects of the current Covid-19 pandemic.
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Affiliation(s)
- Mangrio Elisabeth
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden.,Malmö Institute for Studies of Migration, Diversity and Welfare (MIM), Malmö University, Malmö, Sweden
| | | | - Sjögren Forss Katarina
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Zdravkovic Slobodan
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden.,Malmö Institute for Studies of Migration, Diversity and Welfare (MIM), Malmö University, Malmö, Sweden
| | - Strange Michael
- Malmö Institute for Studies of Migration, Diversity and Welfare (MIM), Malmö University, Malmö, Sweden.,Global Political Studies, Malmö University, Malmö, Sweden
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Wikman-Jorgensen PE, Llenas-Garcia J, Shedrawy J, Gascon J, Muñoz J, Bisoffi Z, Requena-Mendez A. Cost-effectiveness of different strategies for screening and treatment of Strongyloides stercoralis in migrants from endemic countries to the European Union. BMJ Glob Health 2021; 5:bmjgh-2020-002321. [PMID: 32461226 PMCID: PMC7254101 DOI: 10.1136/bmjgh-2020-002321] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The best strategy for controlling morbidity due to imported strongyloidiasis in migrants is unclear. We evaluate the cost-effectiveness of six possible interventions. METHODS We developed a stochastic Markov chain model. The target population was adult migrants from endemic countries to the European Union; the time horizon, a lifetime and the perspective, that of the health system. Average and incremental cost-effectiveness ratios (ACER and ICER) were calculated as 2016 EUR/life-year gained (LYG). Health interventions compared were: base case (no programme), primary care-based presumptive treatment (PCPresTr), primary care-based serological screening and treatment (PCSerTr), hospital-based presumptive treatment (HospPresTr), hospital-based serological screening and treatment (HospSerTr), hospital-based presumptive treatment of immunosuppressed (HospPresTrim) and hospital-based serological screening and treatment of the immunosuppressed (HospSerTrim). The willingness to pay threshold (WTP) was €32 126.95/LYG. RESULTS The base case model yielded a loss of 2 486 708.24 life-years and cost EUR 3 238 393. Other interventions showed the following: PCPresTr: 2 488 095.47 life-years (Δ1 387.23LYG), cost: EUR 8 194 563; ACER: EUR 3573/LYG; PCSerTr: 2 488 085.8 life-years (Δ1377.57LYG), cost: EUR 207 679 077, ACER: EUR 148 407/LYG; HospPresTr: 2 488 046.17 life-years (Δ1337.92LYG), cost: EUR 14 559 575; ACER: EUR 8462/LYG; HospSerTr: 2 488 024.33 life-years (Δ1316.08LYG); cost: EUR 207 734 073; ACER: EUR 155 382/LYG; HospPresTrim: 2 488 093.93 life-years, cost: EUR 1 105 483; ACER: EUR -1539/LYG (cost savings); HospSerTrim: 2 488 073.8 life-years (Δ1365.55LYG), cost: EUR 4 274 239; ACER: EUR 759/LYG. One-way and probabilistic sensitivity analyses were undertaken; HospPresTrim remained below WTP for all parameters' ranges and iterations. CONCLUSION Presumptively treating all immunosuppressed migrants from areas with endemic Strongyloides would generate cost savings to the health system.
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Affiliation(s)
- Philip Erick Wikman-Jorgensen
- Medicina Interna, Hospital Universitari San Juan de Alicante, San Juan de Alicante, Alicante, Spain .,Foundation for the Promotion of the Research in Healthcare and Biomedicine, Valencia, Spain
| | - Jara Llenas-Garcia
- Medicina Interna/Enfermedades Infecciosas, Hospital Vega Baja-FISABIO, San Bartolome-Orihuela, Alicante, Spain.,Clinical Medicine, Universidad Miguel Hernandez de Elche Facultad de Medicina, Sant Joan D'Alacant, Spain
| | - Jad Shedrawy
- Public Health, Karolinska Institutet, Stockholm, Stockholm County, Sweden
| | | | | | - Zeno Bisoffi
- Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Veneto, Italy.,Diagnostics and Public Health, University of Verona, Verona, Veneto, Italy
| | - Ana Requena-Mendez
- Instituto de Salud Global Barcelona, Barcelona, Spain.,Division of Infectious Diseases, Department of Medicine-Solna, Karolinska Institutet, Stockholm, Sweden
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Hansson SO, Helgesson G, Juth N. Who should be tested in a pandemic? Ethical considerations. BMC Med Ethics 2021; 22:76. [PMID: 34158041 PMCID: PMC8218570 DOI: 10.1186/s12910-021-00640-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/08/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In the initial phase of the Covid-19 pandemic, difficult decisions had to be made on the allocation of testing resources. Similar situations can arise in future pandemics. Therefore, careful consideration of who should be tested is an important part of pandemic preparedness. We focus on four ethical aspects of that problem: how to prioritize scarce testing resources, the regulation of commercial direct-to-consumer test services, testing of unauthorized immigrants, and obligatory testing. MAIN TEXT The distribution of scarce resources for testing: We emphasize the use of needs-based criteria, but also acknowledge the importance of choosing a testing strategy that contributes efficiently to stopping the overall spread of the disease. Commercial direct-to-consumer test services: Except in cases of acute scarcity, such services will in practice have to be allowed. We propose that they should be subject to regulation that ensures test quality and adequate information to users. Testing of unauthorized immigrants, their children and other people with unclear legal status: Like everyone else, these individuals may be in need of testing, and it is in society's interest to reach them with testing in order to stop the spread of the disease. A society that offers comprehensive medical services to unauthorized immigrants is in a much better position to reach them in a pandemic than a society that previously excluded them from healthcare. Obligatory testing: While there are often strong reasons for universal testing in residential areas or on workplaces, there are in most cases better ways to achieve testing coverage than to make testing mandatory. CONCLUSION In summary, we propose (1) decision-making primarily based on needs-based criteria, (2) strict regulation but not prohibition of direct-to-consumer test services, (3) test services offered to unauthorized immigrants, preferably as part of comprehensive medical services, and (4) broad outreach of testing services whenever possible, but in general not obligatory testing.
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Affiliation(s)
- Sven Ove Hansson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77, Stockholm, Sweden.
- Division of Philosophy, KTH Royal Institute of Technology, Teknikringen 76, 100 44, Stockholm, Sweden.
| | - Gert Helgesson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Niklas Juth
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77, Stockholm, Sweden
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Affiliation(s)
- Ethel Sequeira-Aymar
- Médica de familia CAPSBE Casanova; Grupo transversal de investigación en AP IDIBAPS, Villarroel 170, 08036 Barcelona, España; Coordinadora grupo COCOOPSI CAMFIC Diputació 316, Barcelona, España.
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de Jezus SV, do Prado TN, Arcêncio RA, Mascarello KC, Sales CMM, Fauth MM, de Faria Marcos Terena N, Amorim RF, Araujo VMS, Aragón MAL, Maciel ELN. Factors associated with latent tuberculosis among international migrants in Brazil: a cross-sectional study (2020). BMC Infect Dis 2021; 21:512. [PMID: 34074249 PMCID: PMC8168318 DOI: 10.1186/s12879-021-06227-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/20/2021] [Indexed: 02/03/2023] Open
Abstract
Background Migrants are a high priority group for TB control measures due to their high exposure to risk factors such as poverty and social vulnerability. The study aimed to identify factors associated with latent TB among international migrants living in four Brazilian state capitals. This was a cross-sectional study conducted in September and October 2020 in a sample of 903 international migrants living in four Brazilian state capitals: Boa Vista/RR (458), Manaus/AM (136), São Paulo/SP (257), and Curitiba/PR (52). Data were collected with a questionnaire consisting of open and closed questions on personal characteristics, information on TB, and use of preventive measures. Tuberculin skin test (TST) was performed, with reading after 72 h by trained nurses and using 5 mm induration as the positive cutoff. Chi-square test (X2) and Fisher’s exact test, both two-tailed, were used to compare statistically significant levels of association between the migrants´ sociodemographic characteristics, vulnerability, and latent TB infection (LTBI). Binary logistic regression was applied to calculate odds ratios and respective 95% confidence intervals. For all the tests, type I error of 5% was defined as statistically significant (p < 0.05). Results Prevalence of LTBI among migrants was 46.1% in Manaus/AM, 33.3% in São Paulo/SP, 28.1% in Curitiba/PR, and 23.5% in Boa Vista/RR. Factors associated with latent infection were age, male gender, and brown or indigenous race. Conclusions The study showed high prevalence of latent TB among international migrants.
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Affiliation(s)
- Sonia Vivian de Jezus
- Epidemiology Laboratory, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
| | | | - Ricardo Alexandre Arcêncio
- Graduate Studies Program in Public Health Nursing, Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
| | - Keila Cristina Mascarello
- Department of Health Sciences, Centro Universitário Norte do Espírito Santo, Universidade Federal do Espírito Santo, São Mateus, ES, Brazil
| | | | - Maysa Mabel Fauth
- Epidemiology Laboratory, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
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Norman FF, Comeche B, Martínez-Lacalzada M, Pérez-Molina JA, Gullón B, Monge-Maillo B, Chamorro S, López-Vélez R. Seroprevalence of vaccine-preventable and non-vaccine-preventable infections in migrants in Spain. J Travel Med 2021; 28:6145914. [PMID: 33611577 DOI: 10.1093/jtm/taab025] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/29/2021] [Accepted: 02/15/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Updated seroprevalence studies of infections in migrants may aid the design of tailored vaccination and prevention programmes. The objective of this study was to describe the seroprevalence rates for potentially transmissible viral infections in migrants attended at a referral centre in a major European city. METHODS Descriptive analysis of seroprevalence of vaccine-preventable and non-vaccine-preventable infections in migrants attended at a centre in Madrid, Spain (2018-19). Recorded variables included age, gender, country of birth/continent of origin, time from arrival to Spain until first clinic visit, rubella, measles, mumps, varicella (VZV), hepatitis B virus (HBV), hepatitis A virus (HAV), hepatitis C virus (HCV) and HIV serology. RESULTS In total, 468 patients were included, 135 females (28.8%) and 333 males (71.2%), mean age 30.4 years. The majority of patients were from Africa (52.5%, of which 88.2% from sub-Saharan Africa), followed by Latin America (38.5%) and other areas (9%). Seroprevalence for tested migrants for rubella, measles and mumps was < 95% in the group overall (91% rubella, 88% measles, 83% mumps) and lower rates were observed in migrants >20 years (compared with those ≤ 20 years). Over 10% of females were potentially susceptible (negative/indeterminate serology) to rubella (11.4%), measles (12.7%) or mumps (10.3%). Lowest rates of rubella seropositivity were in Latin American migrants (over 12% potentially susceptible); measles and mumps seropositivity was lowest in migrants from areas other than Africa/Latin America (74% and 68%, respectively). Seroprevalence rates were 91% for VZV, 90% overall for HAV, ~6% for HBV chronic infection (~50% of migrants tested susceptible), 2% for HCV and 6% for HIV. CONCLUSIONS Differences in seroprevalence for vaccine-preventable and transmissible infections according to gender, age range and area of origin were observed. Tailored screening, vaccination and prevention strategies in potentially vulnerable migrant groups should be designed.
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Affiliation(s)
- Francesca F Norman
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Belén Comeche
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Miguel Martínez-Lacalzada
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | - José-Antonio Pérez-Molina
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Beatriz Gullón
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Begoña Monge-Maillo
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Sandra Chamorro
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Rogelio López-Vélez
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
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Roura M, Dias S, LeMaster JW, MacFarlane A. Participatory health research with migrants: Opportunities, challenges, and way forwards. Health Expect 2021; 24:188-197. [PMID: 33528082 PMCID: PMC8077110 DOI: 10.1111/hex.13201] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/21/2020] [Accepted: 12/31/2020] [Indexed: 12/15/2022] Open
Abstract
CONTEXT Migration is one of the most politically pressing issues of the 21st century but migrant health remains an under-researched area. The International Collaboration for Participatory Health Research (ICPHR) working group on migration developed this position statement to address opportunities and challenges in relation to migrant health. It aims to contribute to a shift from a deficit model that sees migrants as passively affected by policies to their reconceptualization as citizens who are engaged in the co-creation of solutions. METHODS This paper examines the opportunities and challenges posed by the use of PHR with migrants. It draws on a broad literature to provide examples of successful PHR with migrants and highlights critical issues for consideration. FINDINGS Successful initiatives illustrate the value of engaging migrants in the definition of the research agenda, the design and implementation of health interventions, the identification of health-protective factors and the operationalization and validation of indicators to monitor progress. Within increasingly super diverse contexts, fragmented community landscapes that are not necessarily constructed along ethnicity traits, inadequate structures of representation, local tensions and operational barriers can hamper meaningful PHR with migrants. CONCLUSION For each research context, it is essential to gauge the 'optimal' level and type of participation that is more likely to leverage migrants' empowerment. The development of Monitoring and Evaluation tools and methodological strategies to manage inter-stakeholder discrepancies and knowledge translation gaps are steps in this direction. PATIENT OR PUBLIC CONTRIBUTION This paper draws from contributions of migrant populations and other stakeholders to policymaking.
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Affiliation(s)
- Maria Roura
- School of Public HealthUniversity College CorkCorkIreland
| | - Sonia Dias
- NOVA National School of Public Health, Public Health Research CenterUniversidade NOVA de Lisboa & Comprehensive Health Research Center (CHRC)LisboaPortugal
| | | | - Anne MacFarlane
- School of Medicine LimerickLimerickIreland
- Health Research InstituteUniversity of LimerickLimerickIreland
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Tuberculosis in migrants to Australia: Outcomes of a national screening program. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 10:100135. [PMID: 34327348 PMCID: PMC8315463 DOI: 10.1016/j.lanwpc.2021.100135] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 11/21/2022]
Abstract
Background: Few low-incidence countries are on track to achieve the ambitious target of reaching TB pre-elimination by 2035. Australia is a high-income country with a low burden of TB, which is particularly concentrated in migrant populations. As part of Australia's migration program, permanent, provisional and humanitarian visa applicants are screened for TB, along with some applicants for temporary visas. Methods: We calculated the prevalence of all forms of active TB and bacteriologically-confirmed TB among onshore and offshore applicants for visas to Australia from July 2014 to June 2017, and investigated associated risk factors using logistic regression. Findings: Visa applicants were predominantly young adults from various Asian countries. Among 2,381,217 applicants, 1263 cases of active TB were diagnosed, including 852 cases of bacteriologically-confirmed TB. Overall TB prevalence was 53.0 per 100,000, corresponding to one TB diagnosis for every 1887 applicants screened. TB rates increased with age and were higher among humanitarian applicants and those previously treated for TB, although most cases occurred in applicants without these risk factors. TB prevalence by country of origin was similar to WHO estimates for some countries, but considerably lower for others. For several highly represented countries of origin, rates appear to have fallen relative to earlier comparable studies. Interpretation: Prevalence of TB among visa applicants to Australia and the consequent risk to the Australian community appear to be declining and remain low. In this context, support for TB control programs overseas and preventive interventions are likely to have the greatest impact on domestic TB burden. Funding: No specific funding was received for this study. JMT is a recipient of an Early Career Fellowship from the Australian National Health and Medical Research Council (APP1142638).
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Hertting O, Luthander J, Giske CG, Bennet R, Eriksson M. Acute infection as cause of hospitalization of asylum-seeking children and adolescents in Stockholm, Sweden 2015-2016. Eur J Pediatr 2021; 180:893-898. [PMID: 32974759 PMCID: PMC7886722 DOI: 10.1007/s00431-020-03795-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 07/04/2020] [Accepted: 08/26/2020] [Indexed: 11/27/2022]
Abstract
We aimed to identify hospitalizations due to infectious diseases among asylum seekers and compare them to those of the resident population 1.6.2015-31.10.2016. Administrative numbers assigned to hospitalized non-resident children made them identifiable in the discharge register. The examined populations, expressed as person-years, were 334,573 residents and 7565 asylum seekers. There were 2500 episodes of infectious disease in 2240 resident children and 139 episodes in 121 asylum seekers. Among prevalent infections contracted before or during migration, there were 33 cases of tuberculosis, four of malaria, and one of louse-borne relapsing fever, all of which occurred in 13-17-year-old unaccompanied minors. Among younger asylum seekers, there were no significant differences in the spectrum of infectious discharge diagnoses compared to residents, but across all incident infections, 0-6-year-old asylum seekers had 3.2-fold and 7-12-year-old a 4.7-fold greater risk of being admitted. Screening for multidrug-resistant bacteria showed that 45/160 (28%) of the asylum seekers were colonized, but clinical infections caused by these species were rare.Conclusion: There was a high rate of hospitalizations for acute infectious diseases in asylum-seeking children, but the spectrum and severity of infections were similar to that in resident children. What is known: • Mental and physical health problems are common in immigrant children and adolescents. What is new: • Hospitalizations due to acute infections in asylum-seeking children and adolescents are common. In the context of this study, the severity and spectrum of infectious diseases seemed to be the same in the two groups; the increased hospitalization rate in asylum seekers may be due to social factors and perceived need for more support.
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Affiliation(s)
- Olof Hertting
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden. .,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Joachim Luthander
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden ,Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Christian G. Giske
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden ,Division of Clinical microbiology, Department of Laboratory medicine, Karolinska Institutet, Stockholm, Sweden
| | - Rutger Bennet
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Margareta Eriksson
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
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Hayward SE, Rustage K, Nellums LB, van der Werf MJ, Noori T, Boccia D, Friedland JS, Hargreaves S. Extrapulmonary tuberculosis among migrants in Europe, 1995 to 2017. Clin Microbiol Infect 2020; 27:1347.e1-1347.e7. [PMID: 33352301 PMCID: PMC8437049 DOI: 10.1016/j.cmi.2020.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 11/18/2022]
Abstract
Objectives The proportion of tuberculosis (TB) cases occurring in migrants in Europe is increasing. Extrapulmonary TB poses challenges in diagnosis and treatment and causes serious morbidity and mortality, yet its extent in migrant populations is unclear. We assessed patterns of extrapulmonary TB in migrants across the European Union (EU)/European Free Trade Association (EFTA). We investigated the proportion of extrapulmonary TB cases among migrants versus non-migrants, and variations by specific site of disease, reporting European region, and migrant region of origin. Methods We carried out a cross-sectional secondary database analysis, utilizing 23 years of data collected between 1995 and 2017 from the European Surveillance System of the European Centre for Disease Prevention and Control for 32 EU/EFTA countries. Results In total, 1 270 896 TB cases were included, comprising 326 987 migrants (25.7%) and 943 909 non-migrants (74.3%). Of TB cases among migrants, 45.2% (n = 147 814) were extrapulmonary compared to 21.7% (n = 204 613) among non-migrants (p < 0.001). Lymphatic, bone/joint and peritoneal/digestive TB were more common among migrant than non-migrant extrapulmonary cases. A lower proportion of extrapulmonary TB was seen in Eastern Europe (17.4%, n = 98 656 of 566 170) and Southern Europe (29.6%, n = 62 481 of 210 828) compared with Western (35.7%, n = 89 498 of 250 517) and Northern Europe (41.8%, n = 101 792 of 243 381). Migrants from South-East Asia and Sub-Saharan Africa were at highest risk of extrapulmonary disease, with 62.0% (n = 55 401 of 89 353) and 54.5% (n = 38 327 of 70 378) of cases, respectively, being extrapulmonary. Conclusions Among TB cases in the EU/EFTA, extrapulmonary disease is significantly more common in migrants than in non-migrants. There is a need to improve clinical awareness of extrapulmonary TB and to integrate its detection into screening programmes.
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Affiliation(s)
- Sally E Hayward
- Institute for Infection and Immunity, St George's, University of London, London, UK; Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | - Kieran Rustage
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Laura B Nellums
- Institute for Infection and Immunity, St George's, University of London, London, UK; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Teymur Noori
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Delia Boccia
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jon S Friedland
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Sally Hargreaves
- Institute for Infection and Immunity, St George's, University of London, London, UK
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Socha A, Klein J. What are the challenges in the vaccination of migrants in Norway from healthcare provider perspectives? A qualitative, phenomenological study. BMJ Open 2020; 10:e040974. [PMID: 33234649 PMCID: PMC7689063 DOI: 10.1136/bmjopen-2020-040974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/30/2020] [Accepted: 11/05/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Migrant populations in the European Union (EU) suffer a disproportionate burden of infectious diseases and may be particularly vulnerable due to poor conditions in countries of origin or throughout transit to the host country. Given the rising level of migration into Europe, the vaccination of migrant populations has become a key priority, with European countries committing to equitably extending the benefits of vaccination to all. However, in Norway, little is known about the vaccination of migrant populations. OBJECTIVE The aim of this qualitative research study was to explore the process of vaccinating migrant populations in Norway and elucidate any challenges as perceived by healthcare providers. This involved exploring the challenges faced by healthcare providers in delivering vaccinations to migrants as well as potential barriers faced by migrants in accessing vaccinations in Norway, from the perspectives of healthcare providers. METHODS In June 2019, the authors conducted semi-structured interviews with seven healthcare providers who are involved in vaccinating migrants in South-Eastern and Western Norway. This included healthcare providers working in general practice, public health and infectious disease clinics, migrant health clinics, and local public health institutes. RESULTS An inductive, exploratory analysis identified key themes that were reviewed and analysed in light of existing literature. According to the informants, the Childhood Immunisation Programme is effective in including migrant children within the national vaccination schedule. However, gaps in vaccination appear to exist with regards to adult migrants as well as working migrants. There is currently no consistent or structured approach to vaccinating adult migrants in Norway, including no guidelines from governing bodies on how to organise vaccination to adult migrants in municipalities. Furthermore, reasons why adult vaccination is not prioritised were provided, such as tuberculosis screening and treatment taking precedence and the common assumption among healthcare providers that vaccinations are dealt with in childhood. CONCLUSION The development of equitable immunisation programmes requires an understanding of the multifactorial barriers to immunisation, such as those posed by policies, structures and governance bodies, or lack thereof. It also entails understanding the administration of such policies and the perspectives of those who are responsible for the delivery of vaccination, namely healthcare providers. This qualitative research study demonstrated that challenges exist in the vaccination of migrants in Norway and that they are coherent with those experienced throughout the EU, principally the presence of gaps in vaccinating adult migrants, working migrants and internal EU migrants. This research provides direction for future investigations and highlights the need for the inclusion of migrant status in the Norwegian Immunisation Registry.
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Affiliation(s)
- Anna Socha
- Global Health Office, McMaster Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jörn Klein
- Department of Nursing and Health Sciences, University of South-Eastern Norway, Kongsberg, Norway
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Abstract
"Currently, an estimated 70.8 million individuals worldwide are forcibly displaced due to war, violence, and persecution. Barriers to providing dermatologic care include the large number of affected people, their movement within and across international borders, security issues, and limited access to dermatology expertise and formularies. Screening protocols for skin diseases and sexually transmitted infections differ worldwide, raising the need for shared guidelines to assess migrants' health. This article reviews the literature of skin and sexually transmitted infections in migrants and displaced persons, highlighting the impact of social determinants on skin health and challenges faced in providing care."
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Interventions to reduce the burden of vaccine-preventable diseases among migrants and refugees worldwide: A scoping review of published literature, 2006-2018. Vaccine 2020; 38:7217-7225. [PMID: 33008670 DOI: 10.1016/j.vaccine.2020.09.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/21/2020] [Accepted: 09/16/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Disparities in vaccine-preventable disease (VPD) burden and immunisation coverage between migrants and refugees and their host populations have been described in numerous countries worldwide. Effective strategies are required to reduce the health disparities and immunisation inequities experienced by migrants and refugees. METHODS Using Arksey and O'Malley's framework, we conducted a scoping review to identify available literature on interventions aimed at reducing VPD burden among migrants and refugees worldwide. We searched for relevant empirical, peer-reviewed literature published in English between 2006 and 2018 using MEDLINE, Ovid EMBASE, CINAHL, Sociological Abstracts, and Web of Science databases. Relevant information from the studies, including intervention type, details and outcomes, were charted in Microsoft Excel and results were summarised using a descriptive analytical method. RESULTS Seventy studies met the inclusion criteria. The number of published studies increased over the years. The majority of studies were conducted in high-income countries. More studies were conducted among migrants (not including refugees) (n = 48, 66%) than specifically among refugees (n = 25, 34%). Interventions were implemented in a variety of settings, including health care (n = 31, 42%), community (n = 29, 39%), off-shore (n = 7, 9%), national (n = 4, 5%), school (n = 2, 3%), and workplace (n = 1, 1%). Studies reported interventions focused at the individual (to facilitate uptake of health services) (n = 4, 5%), community (to raise awareness) (n = 25, 34%), provider (to offer health services) (n = 12, 16%) and/or system (to increase compliance with recommendations) (n = 33, 45%) level. To be effective, interventions were designed to overcome commonly identified barriers to accessing services related to language, culture, distance and cost. Engagement with community members and organisations was an effective way to co-design interventions that address migrants' specific needs. CONCLUSIONS Studies emphasised the importance of interventions that address the heterogeneity within and between migrant and refugee populations. Considerable variation in practice remains, therefore more evaluation of interventions is needed to inform policy and programme decision-making.
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