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Lin K, Xiang L. Factors Associated with Non-Adherence to Treatment Among Migrants with MDR-TB in Wuhan, China: A Cross-Sectional Study. Risk Manag Healthc Policy 2024; 17:727-737. [PMID: 38559871 PMCID: PMC10981374 DOI: 10.2147/rmhp.s448706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/19/2024] [Indexed: 04/04/2024] Open
Abstract
Background Multidrug resistant tuberculosis (MDR-TB) has attracted increasing attention in achieving the global goal of tuberculosis (TB) control. China has the second largest TB burden worldwide and has been experiencing large-scale domestic migration. This study aims to explore the effect of migrants on non-adherence to MDR-TB treatment. Materials and Methods A cross-sectional study was carried out in Wuhan, China. The exposure cases were migrants who were not locally registered in the residence registration system. The control cases were local residents. Non-adherence cases were patients who were lost follow-up or refused treatment. Chi-square and t-test were used to compare variables between migrants and local residents. Logistic regression models using enter method were used to determine the relationship between migration and non-adherence to treatment. Moderation and medication effects on the association between migrant status and non-adherence were also explored. Results We studied 73 migrants and 219 local residents. The migrants, who did not to adhere to treatment (55, 75.3%), was far higher than that of local residents (89, 40.6%). Migrants with MDR-TB had 10.38-times higher difficulty in adhering to treatment (adjusted OR = 10.38, 95% CI 4.62-25.28) than local residents. This additional likelihood was moderated by age and treatment registration group. Migration had an indirect association with non-adherence to treatment via social medial insurance (adjusted OR = 1.05, 95% CI 1.01-1.13). Conclusion There a significant increased likelihood of non-adherence to treatment among migrants with MDR-TB, highlighting the importance of improving treatment adherence in this population. Migration prevented migrants from gaining access to social medical insurance and indirectly reduced their likelihood of adherence to treatment.
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Affiliation(s)
- Kunhe Lin
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Li Xiang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
- HUST Base of National Institute of Healthcare Security, Wuhan, People’s Republic of China
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Yu S, Jeong D, Kang HY, Kang YA, Lee GI, Choi H. A Quasi-experimental Study on the Effect of Pre-entry Tuberculosis Screening for Immigrants on Treatment Outcomes in South Korea: A Difference-in-Differences Analysis. J Epidemiol Glob Health 2024; 14:154-161. [PMID: 38261173 PMCID: PMC11043236 DOI: 10.1007/s44197-023-00181-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE This study ascertains the effects of the pre-entry tuberculosis (TB) screening policy, which was implemented as a strategy for managing TB among immigrants, on the treatment outcomes of immigrants in South Korea. METHODS This study linked three different datasets from 2013 to 2018, namely (1) Korean National Tuberculosis Surveillance System; (2) National Health Information Database for patients diagnosed with TB with ICD code A15-A19, B90, or U84.3; and (3) Statistics Korea database related to cause of deaths. To identify the effect of the policy, cohorts comprising Korean and immigrant TB patients notified before (January 1, 2013-December 31, 2015) and after (September 1, 2016-December 31, 2018), the implementations of the policy were established. A difference-in-differences (DID) analysis of the treatment success and mortality rates was performed. RESULTS Data from 100,262 TB patients were included in the analysis (before policy implementation: 1240 immigrants and 65,723 Koreans; after policy implementation: 256 immigrants and 33,043 Koreans). The propensity score matching-DID analysis results showed that the difference in the treatment success rate between immigrants and Koreans decreased significantly, from 16% before to 6% after the policy implementation. The difference in the mortality rate between the two groups decreased from - 3% before to - 1% after the policy implementation; however, this difference was insignificant. CONCLUSION The treatment outcomes of immigrant TB patients in South Korea improved after the implementation of the pre-entry active TB screening policy. Future immigrant TB policies should consider establishing active patient support strategies and a healthcare collaboration system between countries.
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Affiliation(s)
- Sarah Yu
- School of Health Policy and Management, College of Health Science, Korea University, Seoul, Republic of Korea
- BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Republic of Korea
| | - Dawoon Jeong
- Department of Preventive Medicine, Seoul National University, Seoul, Republic of Korea
| | - Hee-Yeon Kang
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea
| | - Young Ae Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute for Immunology and Immunological Disease, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gyeong In Lee
- The Korean Institute of Tuberculosis, Korean National Tuberculosis Association, Cheongju, Republic of Korea
| | - Hongjo Choi
- School of Health Policy and Management, College of Health Science, Korea University, Seoul, Republic of Korea.
- BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Republic of Korea.
- Department of Preventive Medicine, College of Medicine, Konyang University, Daejeon, Republic of Korea.
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Adusumelli Y, Tabatneck M, Sherman S, Lamb G, Sabharwal V, Goldmann D, Epee-Bounya A, Haberer JE, Sandora TJ, Campbell JI. Pediatric Tuberculosis Infection Care Facilitators and Barriers: A Qualitative Study. Pediatrics 2024; 153:e2023063949. [PMID: 38327249 DOI: 10.1542/peds.2023-063949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND A total of 700 000 US children and adolescents are estimated to have latent tuberculosis (TB) infection. Identifying facilitators and barriers to engaging in TB infection care is critical to preventing pediatric TB disease. We explored families' and clinicians' perspectives on pediatric TB infection diagnosis and care. METHODS We conducted individual interviews and small group discussions with primary care and subspecialty clinicians, and individual interviews with caregivers of children diagnosed with TB infection. We sought to elicit facilitators and barriers to TB infection care engagement. We used applied thematic analysis to elucidate themes relating to care engagement, and organized themes using a cascade-grounded pediatric TB infection care engagement framework. RESULTS We enrolled 19 caregivers and 24 clinicians. Key themes pertaining to facilitators and barriers to care emerged that variably affected engagement at different steps of care. Clinic and health system themes included the application of risk identification strategies and communication of risk; care ecosystem accessibility; programs to reduce cost-related barriers; and medication adherence support. Patient- and family-level themes included TB knowledge and beliefs; trust in clinicians, tests, and medical institutions; behavioral skills; child development and parenting; and family resources. CONCLUSIONS Risk identification, education techniques, trust, family resources, TB stigma, and care ecosystem accessibility enabled or impeded care cascade engagement. Our results delineate an integrated pediatric TB infection care engagement framework that can inform multilevel interventions to improve retention in the pediatric TB infection care cascade.
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Affiliation(s)
- Yamini Adusumelli
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | | | | | - Gabriella Lamb
- Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts
| | - Vishakha Sabharwal
- Section of Pediatric Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | - Don Goldmann
- Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts
| | | | - Jessica E Haberer
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts
| | - Thomas J Sandora
- Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts
| | - Jeffrey I Campbell
- Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts
- Section of Pediatric Infectious Diseases, Boston Medical Center, Boston, Massachusetts
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Mlangeni N, Malotle M, Made F, Ramodike J, Sikweyiya Y, Du Preez C, Thompson NS, Zungu M. Factors associated with TB screening among agricultural workers in Limpopo Province, South Africa. Glob Health Action 2023; 16:2162227. [PMID: 36661274 PMCID: PMC9869983 DOI: 10.1080/16549716.2022.2162227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) continues to be a public health issue of concern in South Africa. Workers in the agricultural sector are generally at increased risk of TB due to multiple interacting factors such as exposure to silica dust, co-worker infection, and occupations falling within the lower socio-economic sectors. OBJECTIVE This study investigates factors associated with TB screening uptake for agricultural workers in Limpopo Province, South Africa. METHOD This cross-sectional study targeted a study population of 16,787 agricultural workers across 96 agricultural worksites in South Africa. A two-stage cluster random sampling design identified 24 agricultural worksites and a potential 2500 participants. The outcome variable was self-reported TB screening. Descriptive statistics and unadjusted and adjusted logistic regression analyses were performed to determine factors associated with TB screening. A literature review informed the selection of covariates as possible confounders. RESULTS The final study sample comprised 2144 workers across 24 sites, with 55% being women. TB screening uptake was 1155 (56.3%). Factors such as living with human immunodeficiency virus (HIV) (AOR 3.16, 95% CI: 2.44-4.09), accessing health services in the workplace (AOR 1.94, 95% CI: 1.09-3.46), and having prior TB knowledge (AOR 18.45, 95% CI: 9.8-34.74) were positively associated with TB screening. Participants in the age group 36-49 years had significantly higher odds of self-reporting TB screening, compared with those aged 18-25 years (AOR 1.37, 95% CI 1.07-1.77). Migrant workers from Mozambique (OR 0.52, 95% CI: 0.34-0.79) and Zimbabwe (OR 0.71, 95% CI 0.57-0.89) were significantly less likely to self-report TB screening compared to their South African counterparts. CONCLUSION The findings underscore the importance of workplace health services in achieving end-TB targets. We recommend programs and interventions for preventing TB in South Africa that target the agricultural sector in general, and in particular migrant workers.
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Affiliation(s)
- Nosimilo Mlangeni
- National Institute for Occupational Health, A division of the National Health Laboratory Service, Johannesburg, South Africa,Department of Global Health, Stellenbosch University, Cape Town, South Africa,CONTACT Nosimilo Mlangeni National Institute for Occupational Health, 25 Hospital Street, Braamfontein2001
| | - Molebogeng Malotle
- National Institute for Occupational Health, A division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Felix Made
- National Institute for Occupational Health, A division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Jonathan Ramodike
- National Institute for Occupational Health, A division of the National Health Laboratory Service, Johannesburg, South Africa,School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Yandisa Sikweyiya
- Gender & Health Research Unit, South African Medical Research Council, Pretoria, South Africa,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Muzimkhulu Zungu
- National Institute for Occupational Health, A division of the National Health Laboratory Service, Johannesburg, South Africa,School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
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Kidy F, McCarthy N, Seers K. From symptom onset to treatment initiation: protocol for a narrative study exploring the journey of older adults with tuberculosis in the English Midlands, UK. BMJ Open 2023; 13:e070933. [PMID: 37977875 PMCID: PMC10660672 DOI: 10.1136/bmjopen-2022-070933] [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: 12/08/2022] [Accepted: 10/18/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION Time from symptom onset to treatment initiation in tuberculosis (TB) remains stubbornly prolonged despite reductions in disease incidence. Delays may contribute to increased morbidity, mortality, onward spread of disease and poor patient experiences. Most delays occur prior to hospital referral. The average primary care healthcare provider in England is unlikely to see TB on a regular basis. Little is known about primary care diagnostic and referral challenges.Adults aged 65 years or older are more likely to experience delays. However, little is known about their journey from symptom onset to treatment initiation. METHODS AND ANALYSIS We will carry out a narrative study including adults aged 65 years or older, living in the English Midlands and receiving treatment for active TB. Twelve English and 12 Urdu or Punjabi speakers will be recruited from TB clinics and interviewed. Their primary care records will be accessed, and the primary care story and secondary care letters will be extracted. Each of the data sources will be analysed using dialogical narrative analysis. Data will be triangulated within participants and across the data set. ETHICS AND DISSEMINATION This study received approval from the Health Research Authority and the Research Ethics Committee in April 2022. Risk management and equity considerations have been made a priority. Findings will be disseminated through publication in open access peer-reviewed journals, presentations to policy makers, primary healthcare and secondary healthcare professionals, and through public facing materials developed in conjunction with patients, members of the pubic, TB services and charities.
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Affiliation(s)
- Farah Kidy
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Noel McCarthy
- Population Health Medicine, Public Health & Primary Care, Trinity College Dublin, Dublin, Ireland
| | - Kate Seers
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, UK
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Xie Y, Shum TT, Tian Z, Lin C, Chen L, Chen B, Huang D, Zhu L, Zou G. Diagnostic delay, treatment duration and outcomes since the implementation of integrated model of tuberculosis control and their associated factors in a county in East China. BMC Infect Dis 2023; 23:727. [PMID: 37880574 PMCID: PMC10601170 DOI: 10.1186/s12879-023-08561-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 08/24/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE This study assesses the diagnostic delay, treatment duration and treatment outcomes of tuberculosis (TB) patients since the implementation of the integrated model of TB control in a county in eastern China. It further identifies factors associated with diagnostic delay and treatment duration in the integrated model. METHODS We collected data through the Chinese Tuberculosis Information Management System (TBIMS) for Cangnan County in Zhejiang Province. Chi-square and Mann-Whitney tests were adopted to identify factors associated with duration of treatment and treatment delay for TB patients within the integrated model. Multiple regression analysis was subsequently performed to confirm the identified factors. RESULTS In the integrated model from 2012 to 2018, the median health system delay was maintained at 1 day, and the median patient delay decreased from 14 to 9 days and the median total delay decreased from 15 to 11 days. In addition, the proportion of patients who experienced patient delay > 14 days and total delay > 28 days decreased from 49% to 35% and from 32% to 29% respectively. However, the proportion of patients who had health system delay > 14 days increased from 0.2% to 13% from 2012 to 2018. The median treatment duration increased from 199 to 366 days and the number of TB patients lost to follow-up showed an overall upward trend from 2012 to 2018. The multivariable regression analysis indicated that migrant TB patients and TB patients initially diagnosed in hospitals at the prefectural level and above tended to experience total delay > 28 days (p < 0.001). Linear regression analysis confirmed that new TB patients>60 years tended to have longer treatment duration (p < 0.05). CONCLUSIONS While our study may suggest the potential of the integrated model in early detection and diagnosis of TB, it also suggests the importance of strengthening supervision and management of designated hospitals to optimize the treatment duration and improve retention of patients in TB care. Enhancing health education for TB patients, especially amongst migrant patients, and training in TB identification and referral for non-TB doctors are also key for early TB detection and diagnosis in the integrated model.
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Affiliation(s)
- Yuanxiang Xie
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ting Ting Shum
- Department of Social Anthropology, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Zhenming Tian
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chuanheng Lin
- Center for Public Health, Longgang County, Wenzhou, Zhejiang Province, China
| | - Lingyuan Chen
- Center for Disease Prevention and Control, Cangnan County, Wenzhou, Zhejiang Province, China
| | - Bin Chen
- Zhejiang Provincial Center for Disease Prevention and Control, Hangzhou, China
| | - Dajiang Huang
- Center for Public Health, Longgang County, Wenzhou, Zhejiang Province, China
| | - Lei Zhu
- School of Postgraduate Studies, Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Guanyang Zou
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China.
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De Foo C, Wu S, Amin F, Rajaraman N, Cook AR, Legido-Quigley H. A qualitative exploration of factors that influence the uptake of tuberculosis services by low-skilled migrant workers in Singapore. BMC Health Serv Res 2023; 23:943. [PMID: 37659999 PMCID: PMC10475191 DOI: 10.1186/s12913-023-09938-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/18/2023] [Indexed: 09/04/2023] Open
Abstract
INTRODUCTION Singapore relies heavily on migrant workers to build its country and harbours a relatively large population of these workers. Importantly, tuberculosis (TB) remains a pernicious threat to the health of these workers and in line with the United Nations High-Level Meeting in 2023, this paper aims to uncover the qualitative discourse facing migrant workers' uptake of TB services and provide policy recommendations to enable more equitable access to TB services for this population. METHODS In-depth interviews were carried out with the migrant worker population recruited from a non-governmental organisation in Singapore that serves migrant workers through the provision of primary healthcare services, counselling, and social assistance. Interviews stopped once thematic saturation was achieved and no new themes and subthemes were found. RESULTS A total of 29 participants were interviewed, including 16 Bangladeshis and 13 Chinese, aged between 22 and 54 years old, all worked in the construction sector. Four key themes emerged. They are (1) General TB knowledge: Misconceptions are prevalent, where we found that participants were aware of the disease but did not possess a clear understanding of its pathophysiology and associated health effects, (2) Contextual knowledge and perception of associated policies related to TB in Singapore: low awareness among migrant workers as participants' accounts depicted a lack of information sources in Singapore especially on issues related to healthcare including TB, (3) Attitude to towards TB: Motivation to seek treatment is underpinned by ability to continue working and (4) Stigma: mixed perception of how society views TB patients. The gaps identified in migrant workers' TB knowledge, their attitude towards the disease and their perception of the availability of TB-related services is despite Singapore's efforts to curb community spread of TB and its proactive initiatives to reduce the prevalence. CONCLUSION Our study illuminates the various aspects that policymakers need to home in on to ensure this vulnerable group is sufficiently supported and equitably cared for if they develop active TB during their stay in Singapore as they contribute to the nation's economy. Leveraging the COVID-19 pandemic as a window of opportunity to improve overall healthcare access for vulnerable groups in Singapore can be a starting point.
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Affiliation(s)
- Chuan De Foo
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
- Duke-NUS Graduate Medical School, Singapore, Singapore.
| | - Shishi Wu
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Fariha Amin
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Natarajan Rajaraman
- HealthServe Community Clinic, Singapore, Singapore
- Maluk Timor, Dili, Timor Leste, Timor-Leste
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Imperial College and the George Institute for Global Health, London, UK
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Shamputa IC, Law MA, Kelly C, Nguyen DTK, Burdo T, Umar J, Barker K, Webster D. Tuberculosis related barriers and facilitators among immigrants in Atlantic Canada: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001997. [PMID: 37276222 DOI: 10.1371/journal.pgph.0001997] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/09/2023] [Indexed: 06/07/2023]
Abstract
Tuberculosis (TB) is a disease caused by the bacterium Mycobacterium tuberculosis and affects approximately one-quarter of the world's population. Immigrant populations in Canada are disproportionately affected by TB. Canada's immigration medical examinations include screening for active TB but not latent TB infection (LTBI). In LTBI, the bacterium remains dormant within the host but can reactivate and cause disease. Once active, TB can be transmitted to close contacts sharing confined spaces leading to the possibility of outbreaks in the broader community. This study aimed to 1) assess the current TB knowledge, perceived risk, and risk behaviors of immigrants in Atlantic Canada as well as 2) identify barriers and facilitators to testing and treatment of TB among this population. Three focus group discussions were conducted with a total of 14 non-Canadian born residents of New Brunswick aged 19 years and older. Data were analyzed using inductive thematic analysis. Four themes were identified from the data relating to barriers to testing and treatment of LTBI: 1) Need for education, 2) stigma, 3) fear of testing, treatment, and healthcare system, and 4) complacency. Results included reasons individuals would not receive TB testing, treatment, or seek help, as well as facilitators to testing and treatment. These findings may inform the implemention of an LTBI screening program in Atlantic Canada and more broadly across the country.
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Affiliation(s)
- Isdore Chola Shamputa
- Department of Nursing & Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Moira A Law
- Department of Psychology, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Clara Kelly
- Department of Nursing & Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Duyen Thi Kim Nguyen
- Government of New Brunswick, Department of Health, Saint John, New Brunswick, Canada
- Faculty of Business, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Tatum Burdo
- Dalhousie University New Brunswick, MD Program, Saint John, New Brunswick, Canada
| | - Jabran Umar
- Dalhousie University New Brunswick, MD Program, Saint John, New Brunswick, Canada
| | - Kimberley Barker
- Government of New Brunswick, Department of Health, Saint John, New Brunswick, Canada
| | - Duncan Webster
- Division of Microbiology, Department of Laboratory Medicine, Saint John Regional Hospital, Saint John, New Brunswick, Canada
- Dalhousie Medicine New Brunswick, Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
- Division of Infectious Diseases, Department of Medicine, Saint John Regional Hospital, Saint John, New Brunswick, Canada
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de Almeida Soares D, Arcêncio RA, Fronteira I. Inequities between migrants and non-migrants with TB: Surveillance evidence from the Brazilian border State of Roraima. One Health 2023; 16:100473. [PMID: 36578656 PMCID: PMC9791919 DOI: 10.1016/j.onehlt.2022.100473] [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: 09/30/2022] [Revised: 12/08/2022] [Accepted: 12/08/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction Until 2014, there was already a significant burden of TB in Roraima, with this State being among the most affected ones in Brazil. Since 2015, though, there has been a progressive increase in cases of TB in the state of Roraima, with a notorious concentration of cases in Venezuelan migrants. Active international migration in border territories should be seen as a warning signal about the need to strengthen health surveillance and One Health actions that encompass all components involved in the risk of active transmission of diseases as tuberculosis in these scenarios. Objective This study aims to analyze and compare migrants and non-migrants notified with TB in the State of Roraima in Brazil and identify inequities in terms of diagnosis, access to treatment and outcome of the disease. Study design Quantitative, cross-sectional, descriptive study of all confirmed cases of TB notified in the Information System for Notifiable Diseases (SINAN) between 2009 and 2019. Methods Data were described through counts, frequencies, prevalence ratios and 95% confidence interval. We used Poisson regression with robust variance to adjust for confounders. Results 2111 cases of TB were reported in Roraima between 2009 and 2019 and in this study (mean age 38.2 ± 18.5 years). Cases were more frequently males, brownish race, indigenous people, with high school level education. 10.9% (n = 181) of TB cases were migrants, mainly from Venezuela (72.9%). Migrants with TB were more prone to be homeless (PR = 3.7). A higher number of cases of readmission after treatment dropout (3.3%) and AIDS diseases (11.2%) was observed among migrants compared to non-migrants. The proportion of DR-TB was higher among migrants. The percent of cure of TB was lower among migrants and the prevalence of abandonment of treatment, transfers and deaths by other causes was higher compared to non-migrants. Conclusions The results of the study have shown considerable differences in the epidemiological profile of TB between migrants and non-migrants living in the State of Roraima, with a tendency for poorer outcomes in the first ones as well as more concentration of vulnerabilities. These results stress out existing inequities between migrants and non-migrants with TB disease and raise questions on the health care network capacity to address these.
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Affiliation(s)
- Débora de Almeida Soares
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical da Universidade NOVA de Lisboa, Rua da Junqueira, 100, 1349-008 Lisbon, Portugal
| | - Ricardo A. Arcêncio
- Ribeirão Preto School of Nursing, Escola de Enfermagem de Ribeirão Preto, Rua Prof. Hélio Lourenço, 3900 - Vila Monte Alegre, 14040-902 Ribeirão Preto, SP, Brazil
| | - Inês Fronteira
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical da Universidade NOVA de Lisboa, Rua da Junqueira, 100, 1349-008 Lisbon, Portugal
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Lei Y, Wang J, Wang Y, Xu C. Geographical evolutionary pathway of global tuberculosis incidence trends. BMC Public Health 2023; 23:755. [PMID: 37095497 PMCID: PMC10123998 DOI: 10.1186/s12889-023-15553-7] [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: 08/19/2022] [Accepted: 03/28/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUNDS Tuberculosis (TB) remains a serious public health and human development problem, especially in developing countries. Despite the effectiveness of directly observed therapy, short course programs in reducing transmission and progression of TB, poverty reduction and socioeconomic development remain crucial factors in decreasing TB incidence. However, the geographical pathway on the planet is not yet clear. OBJECTIVES This study was to reconstruct the geographical evolutionary process of TB in 173 countries and territories from 2010 to 2019 to analyze the socioeconomic determinants that impact the global TB epidemic. In addition, the TB incidence in 2030 was predicted. METHODS This study analyses TB incidence data from 173 countries and territories between 2010 and 2019. The Geotree model would be used to reconstruct the geographical evolutionary process of TB, which provides a simplified schema for geo-visualizing the trajectories of TB incidence and their socioeconomic drivers. Additionally, to estimate the future TB incidence in 2030, a multilevel model was utilized in conjunction with the hierarchical nature of the Geotree based on a stratified heterogeneity analysis. RESULTS Global TB incidence was found to be associated with the country type and development stages. Between 2010 and 2019, the average TB incidence rate in 173 countries and territories was -27.48%, with marked spatially stratified heterogeneity by country type and development stage. Low-income and lower-middle-income countries were most vulnerable to TB. Upper-middle-income countries experienced a faster decline in TB incidence than high-income countries, and TB incidence generally decreased as the development stage increased, except for the lower-middle development stage in 2019.The highest average rate of decline in TB incidence was observed in the upper-middle development stage of high-income countries, with a reduction of 45.24%. Meanwhile, 37 high-income countries in the high development stage demonstrated an average rate of change of -13.93%. Socioeconomic determinants, including gross domestic product per capita, urbanization rate, and sociodemographic index, were found to inhibit TB incidence. Based on current trends, the predicted average global TB incidence in 2030 is 91.581 per 100,000 population. CONCLUSIONS The trajectories of the global TB incidence have been reconstructed to formulate targeted public health responses. To eliminate TB, countries at similar development stage can draw on the experiences of countries at higher development stages that are tailored to their unique characteristics. By learning from successful TB control strategies, countries can take strategic steps toward eradicating TB and improving public health outcomes.
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Affiliation(s)
- Yanhui Lei
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Jinfeng Wang
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101, China.
- University of Chinese Academy of Sciences, Beijing, 100049, China.
| | - Yang Wang
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Chengdong Xu
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
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11
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Li T, Du X, Kang J, Luo D, Liu X, Zhao Y. Patient, Diagnosis, and Treatment Delays Among Tuberculosis Patients Before and During COVID-19 Epidemic - China, 2018-2022. China CDC Wkly 2023; 5:259-265. [PMID: 37138894 PMCID: PMC10150750 DOI: 10.46234/ccdcw2023.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/22/2023] [Indexed: 05/05/2023] Open
Abstract
What is already known about this topic? The coronavirus disease (COVID-19) pandemic could have a damaging impact on access to tuberculosis (TB) diagnosis and treatment. What is added by this report? The overall delay experienced by TB patients during the COVID-19 pandemic has shown a modest decrease in comparison to the period before the pandemic. Notably, higher patient delays were observed among agricultural workers and those identified through passive case-finding methods. Furthermore, the patient delay in eastern regions was shorter compared to western and central regions. What are the implications for public health practice? The observed increase in patient delay in 2022 should be of concern for ongoing TB control efforts. Health education and active screening initiatives must be enhanced and broadened among high-risk populations and regions characterized by extended patient delays.
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Affiliation(s)
- Tao Li
- National Center for Tuberculosis Control and Prevention, China CDC, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Xin Du
- National Center for Tuberculosis Control and Prevention, China CDC, Beijing, China
| | - Jiaojie Kang
- National Center for Tuberculosis Control and Prevention, China CDC, Beijing, China
| | - Dan Luo
- Department of Public Health, Hangzhou Medical College, Hangzhou City, Zhejiang Province, China
| | - Xiaoqiu Liu
- National Center for Tuberculosis Control and Prevention, China CDC, Beijing, China
| | - Yanlin Zhao
- National Center for Tuberculosis Control and Prevention, China CDC, Beijing, China
- Yanlin Zhao,
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12
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Umana B, Vorstermans J, Lewa R, Garcia D, Malar J, Daftary A. Transforming the language used in tuberculosis care. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001657. [PMID: 36963075 PMCID: PMC10035744 DOI: 10.1371/journal.pgph.0001657] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Affiliation(s)
- Beauty Umana
- School of Global Health and Dahdaleh Institute of Global Health Research, York University, Toronto, Canada
- Department of African Studies and Linguistics, University of Cape Town, Cape Town, South Africa
- School of Health Policy & Management, York University, Toronto, Canada
| | | | | | - Deliana Garcia
- Migrant Clinicians Network, Austin, Texas, United States of America
| | | | - Amrita Daftary
- School of Global Health and Dahdaleh Institute of Global Health Research, York University, Toronto, Canada
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
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13
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Accelerating UN Sustainable Development Goals with AI-Driven Technologies: A Systematic Literature Review of Women's Healthcare. Healthcare (Basel) 2023; 11:healthcare11030401. [PMID: 36766976 PMCID: PMC9914215 DOI: 10.3390/healthcare11030401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/24/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
In this paper, we critically examine if the contributions of artificial intelligence (AI) in healthcare adequately represent the realm of women's healthcare. This would be relevant for achieving and accelerating the gender equality and health sustainability goals (SDGs) defined by the United Nations. Following a systematic literature review (SLR), we examine if AI applications in health and biomedicine adequately represent women's health in the larger scheme of healthcare provision. Our findings are divided into clusters based on thematic markers for women's health that are commensurate with the hypotheses that AI-driven technologies in women's health still remain underrepresented, but that emphasis on its future deployment can increase efficiency in informed health choices and be particularly accessible to women in small or underrepresented communities. Contemporaneously, these findings can assist and influence the shape of governmental policies, accessibility, and the regulatory environment in achieving the SDGs. On a larger scale, in the near future, we will extend the extant literature on applications of AI-driven technologies in health SDGs and set the agenda for future research.
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14
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Dilas D, Flores R, Morales-García WC, Calizaya-Milla YE, Morales-García M, Sairitupa-Sanchez L, Saintila J. Social Support, Quality of Care, and Patient Adherence to Tuberculosis Treatment in Peru: The Mediating Role of Nurse Health Education. Patient Prefer Adherence 2023; 17:175-186. [PMID: 36704124 PMCID: PMC9871033 DOI: 10.2147/ppa.s391930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/07/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Peru is one of the countries with the highest burden of tuberculosis (TB) and multidrug-resistant tuberculosis (MDR-TB) in the Latin American region and globally. Health education provided by nurses reinforces social support and the quality of patient care allows a greater impact on adherence to TB treatment. PURPOSE This study evaluated the mediating effect of treatment education between social support, quality of care, and treatment adherence in TB patients. METHODS A cross-sectional study was carried out considering 162 adult TB patients from four health centers of the public sector located in the center of the city of Lima, Peru. Data were collected on variables, such as social support, quality of care, health education, and adherence to TB treatment. SmartPLS was used for data analysis. RESULTS The results showed that social support and quality of care significantly influence health education. Likewise, health education mediates social support and quality of care for better adherence to treatment. CONCLUSION It is recommended that hospitals take initiatives to provide better health education on TB treatment to ensure better adherence to treatment.
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Affiliation(s)
- Delker Dilas
- Unit of Public Health, Postgraduate School, Peruvian Union University, Lima, Perú
| | - Rosarias Flores
- Unit of Public Health, Postgraduate School, Peruvian Union University, Lima, Perú
| | - Wilter C Morales-García
- Unit of Public Health, Postgraduate School, Peruvian Union University, Lima, Perú
- Correspondence: Wilter C Morales-García, Unit of Public Health, Postgraduate School, Peruvian Union University, Km 19, Carretera Central, Lima, 15033, Perú, Email
| | | | | | | | - Jacksaint Saintila
- School of Medicine, Señor de Sipán University, Chiclayo, Perú
- Jacksaint Saintila, School of Medicine, Señor de Sipán University, Km 5, Carretera a Pimentel, Chiclayo, 14001, Lambayeque, Perú, Email
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15
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Bedingfield N, Lashewicz B, Fisher D, King-Shier K. Systems of support for foreign-born TB patients and their family members. Public Health Action 2022; 12:79-84. [PMID: 35734012 PMCID: PMC9176195 DOI: 10.5588/pha.21.0081] [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: 11/04/2021] [Accepted: 03/14/2022] [Indexed: 01/24/2023] Open
Abstract
SETTING Adverse social determinants of health for people who are foreign-born are key drivers of TB-related disparity, particularly in low-incidence countries. Patients diagnosed with infectious TB and their family members must confront psychosocial challenges which may deepen pre-existing health inequities. However, little is known about patient and family members' perspective on these experiences. OBJECTIVE To explore the infectious TB experience of patients and family members who are foreign-born. DESIGN This study formed one component of an ecologically framed, qualitative case study conducted in Calgary, AB, Canada. Data were collected using semi-structured interviews, chart review and field notes, and analysed thematically. RESULTS Eight families were represented in the sample comprised of six patients and 13 family members. Many patients and family members experienced high levels of fear and stress for months following the patient's diagnosis. Isolation was pervasive and multifaceted for both patients and family members. Intra-family support was critical for managing during early stages when the situation was most challenging. Support from outside the family was not prominent and attempts to obtain support from government programmes for paid sick leave and health insurance were mostly unsuccessful. CONCLUSION Patients and family members who are foreign-born experience multidimensional isolation as a result of TB stigma, language barriers and poor access to government programmes. TB programmes cannot meet family needs alone and systems of support should be created through collaboration with government institutions, and organisations serving ethnocultural communities.
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Affiliation(s)
- N Bedingfield
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - B Lashewicz
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - D Fisher
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - K King-Shier
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Faculty of Nursing, University of Calgary, Professional Faculties Calgary, AB, Canada
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16
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Buregyeya E, Atusingwize E, Sekandi JN, Mugambe R, Nuwematsiko R, Atuyambe L. Developing strategies to address barriers for tuberculosis case finding and retention in care among refugees in slums in Kampala, Uganda: a qualitative study using the COM-B model. BMC Infect Dis 2022; 22:301. [PMID: 35346094 PMCID: PMC8962141 DOI: 10.1186/s12879-022-07283-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 03/15/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Globally, displaced populations face an increased burden of tuberculosis (TB). Uganda is currently hosting unprecedented big numbers of refugees from the East African region. Recent evidence shows increased spread of multi-drug resistant TB (MDR-TB) across East Africa as a result of migrants from Somalia- a high MDR-TB prevalent country, calling for urgent identification and management of cases for the countries in the region. One of the strategies recommended is optimization of diagnosis, treatment and prevention of TB in refugees. This study aimed at exploring the barriers to and facilitators for TB case finding and retention in care among urban slum refugees and suggestions on how to improve. This was to guide the development of interventions to improve TB case finding and retention in care among the said population.
Methods
A cross-sectional study utilizing qualitative methods was conducted among refugees in an urban slum in Kampala City, Uganda. Key informant interviews with health care workers and community leaders and in-depths interviews with refugee TB patients and care takers of TB patients were conducted (30 interviews in total). Interview questions were based on constructs from the COMB-B model (Capability, Opportunity and Motivation Model of Behaviour change). Manual content analysis was performed and identified targeted intervention strategies guided by the related Behavior Change Wheel implementation framework.
Results
Key barriers included; physical capability (availability of and easily accessible private facilities in the community with no capacity to diagnose and treat TB), psychological capability (lack of knowledge about TB among refugees), social opportunity (wide spread TB stigma and language barrier), physical opportunity (poor living conditions, mobility of refugees), reflective motivation (lack of facilitation for health workers), automatic motivation (discrimination and rejection of TB patients). Facilitators were; physical capability (availability of free TB services in the public health facilities), social opportunity (availability of translators). We identified education, incentivization, training, enablement, and restructuring of the service environment as relevant intervention functions with potential to address barriers to and enhance facilitators of TB case finding and retention among refugees in urban slums.
Conclusion
The key barriers to TB control among refugees living urban slums in Kampala- Uganda, included; poor access to health services, limited knowledge about TB, TB stigma, language barrier and lack of facilitation of community health workers. Identified intervention strategies included; education, training, enablement, environmental restructuring and persuasion. The findings could serve as a guide for the design and implementation of interventions for improving the same.
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17
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Santos JA, Leite A, Soares P, Duarte R, Nunes C. Delayed diagnosis of active pulmonary tuberculosis - potential risk factors for patient and healthcare delays in Portugal. BMC Public Health 2021; 21:2178. [PMID: 34837969 PMCID: PMC8627051 DOI: 10.1186/s12889-021-12245-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early diagnosis and treatment of pulmonary tuberculosis (PTB) is essential for an effective control of the tuberculosis (TB) epidemic. Delayed diagnosis and treatment of TB increases the chance of complications and mortality for the patients, and enhances TB transmission in the population. Therefore, the aim of this study was to characterize patient, healthcare and total delay in diagnosing PTB and assess the effect of clinical and sociodemographic factors on the time until first contact with healthcare or reaching a PTB diagnosis. METHODS Retrospective cohort study that included active PTB patients notified in the National Tuberculosis Surveillance System (SVIG-TB), between 2008 and 2017. Descriptive statistics, Kaplan-Meier estimates, logrank test and Cox proportional hazards model were used to characterize patient, healthcare and total delay and estimate the effect of clinical and sociodemographic variables on these delays. Significance level was set at 0.05. RESULTS Median patient, healthcare and total delays was 37 days (Interquartile range (IQR): 19-71), 8 days (IQR: 1-32) and 62 days (IQR: 38-102), respectively. The median patient delay showed a constant increase, from 33 days in 2008 to 44 days in 2017. The median total delay presented a similar trend, increasing from 59 days in 2008 to 70 days in 2017. Healthcare delay remained constant during the study period. More than half of the PTB cases (82.9%) had a delay > 1 month between symptom onset and diagnosis. In the final Cox model, alcohol abuse, unemployment and being from a high TB incidence country were factors significantly associated with longer patient delay, while being female, having more than 45 years, oncologic and respiratory diseases were associated with longer healthcare delay. Being female, having more than 45 years and being from a high TB incidence country were associated with longer total delay. CONCLUSIONS Patient delay and total delay have increased in recent years. Older patients, patients with alcohol problems, other comorbidities, unemployed or from countries with high TB incidence would benefit from the development of specific public health strategies that could help reduce the delay in TB diagnosis observed in our study. This study emphasizes the need to promote awareness of TB in the general population and among the healthcare community, especially at ambulatory care level, in order to reduce the gap between beginning of symptoms and TB diagnosis.
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Affiliation(s)
- João Almeida Santos
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisbon, Portugal.
- National Health Institute Dr. Ricardo Jorge, Avenida Padre Cruz, 1600-560, Lisbon, Portugal.
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Campo Mártires da Pátria, 1169-056, Lisbon, Portugal.
| | - Andreia Leite
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Campo Mártires da Pátria, 1169-056, Lisbon, Portugal
| | - Patrícia Soares
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Campo Mártires da Pátria, 1169-056, Lisbon, Portugal
| | - Raquel Duarte
- Chest Disease Center, Vila Nova de Gaia, Rua Conselheiro Veloso da Cruz, 4400-092, Vila Nova de Gaia, Portugal
- Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Carla Nunes
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Campo Mártires da Pátria, 1169-056, Lisbon, Portugal
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18
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Marx FM, Hauer B, Menzies NA, Haas W, Perumal N. Targeting screening and treatment for latent tuberculosis infection towards asylum seekers from high-incidence countries - a model-based cost-effectiveness analysis. BMC Public Health 2021; 21:2172. [PMID: 34836526 PMCID: PMC8622109 DOI: 10.1186/s12889-021-12142-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/01/2021] [Indexed: 11/26/2022] Open
Abstract
Background Enhancing tuberculosis (TB) prevention and care in a post-COVID-19-pandemic phase will be essential to ensure progress towards global TB elimination. In low-burden countries, asylum seekers constitute an important high-risk group. TB frequently arises post-immigration due to the reactivation of latent TB infection (LTBI). Upon-entry screening for LTBI and TB preventive treatment (TPT) are considered worthwhile if targeted to asylum seekers from high-incidence countries who usually present with higher rates of LTBI. However, there is insufficient knowledge about optimal incidence thresholds above which introduction could be cost-effective. We aimed to estimate, among asylum seekers in Germany, the health impact and costs of upon-entry LTBI screening/TPT introduced at different thresholds of country-of-origin TB incidence. Methods We sampled hypothetical cohorts of 30–45 thousand asylum seekers aged 15 to 34 years expected to arrive in Germany in 2022 from cohorts of first-time applicants observed in 2017–2019. We modelled LTBI prevalence as a function of country-of-origin TB incidence fitted to data from observational studies. We then used a probabilistic decision-analytic model to estimate health-system costs and quality-adjusted life years (QALYs) under interferon gamma release assay (IGRA)-based screening for LTBI and rifampicin-based TPT (daily, 4 months). Incremental cost-effectiveness ratios (ICERs) were calculated for scenarios of introducing LTBI screening/TPT at different incidence thresholds. Results We estimated that among 15- to 34-year-old asylum seekers arriving in Germany in 2022, 17.5% (95% uncertainty interval: 14.2–21.6%) will be latently infected. Introducing LTBI screening/TPT above 250 per 100,000 country-of-origin TB incidence would gain 7.3 (2.7–14.8) QALYs at a cost of €51,000 (€18,000–€114,100) per QALY. Lowering the threshold to ≥200 would cost an incremental €53,300 (€19,100–€122,500) per additional QALY gained relative to the ≥250 threshold scenario; ICERs for the ≥150 and ≥ 100 thresholds were €55,900 (€20,200–€128,200) and €62,000 (€23,200–€142,000), respectively, using the next higher threshold as a reference, and considerably higher at thresholds below 100. Conclusions LTBI screening and TPT among 15- to 34-year-old asylum seekers arriving in Germany could produce health benefits at reasonable additional cost (with respect to international benchmarks) if introduced at incidence thresholds ≥100. Empirical trials are needed to investigate the feasibility and effectiveness of this approach.
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Affiliation(s)
- Florian M Marx
- Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Berlin, Germany. .,Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa. .,DSI-NRF South African Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa.
| | - Barbara Hauer
- Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Berlin, Germany
| | - Nicolas A Menzies
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Walter Haas
- Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Berlin, Germany
| | - Nita Perumal
- Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Berlin, Germany.,Immunization Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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Panin F, Orlandini E, Galli L, De Martino M, Chiappini E. Tuberculosis burden in immigrants and natives, adults and children, in Tuscany between 2000-2018. Travel Med Infect Dis 2021; 44:102185. [PMID: 34715364 DOI: 10.1016/j.tmaid.2021.102185] [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: 12/13/2019] [Revised: 09/16/2021] [Accepted: 10/18/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Updated data on epidemiology of tuberculosis are needed in Italy. The aim of this study is to evaluate trends in incidence and associated lethality of tuberculosis in immigrants compared with Italians. METHODS All tuberculosis cases diagnosed from 2000 to 2018 in 31 Tuscan hospitals were retrospectively identified. RESULTS In 10,827 tuberculosis cases 6715 were males (62%), 4312 (60%) were Italian-born. Hospitalization rate was 15.37/100,000 population/year. The most common comorbidity were liver disease (832/10,827; 7.7%), COPD (675/10,827; 6.2%), cancer (614/10,827; 5.7%). HIV was more frequent in the immigrants (p < 0.001). Extra-pulmonary tuberculosis cases (EPTB) were mainly localized in pleura (740/3,894, 19%) and lymph nodes (449/3,894, 11,5%). HIV was associated with an increased risk of EPTB (OR 3.51 95% CI 2.92-4.23, p < 0.0001). EPTB risk was increased in South Asian-born patients (OR 1.77, 95% CI 1.46-2.15, p < 0.0001) as well in African-born patients (OR 1.13, 95% CI 1.03-1.24, p = 0.0091), who were at risk for gastroenteric tuberculosis (OR 3.74, 95% CI 2.69-5.22, p < 0.0001). Overall mortality rate was 0.006 per 1000. Most of death cases (89%) were Italians (p < 0.02) and mainly affected by pulmonary tuberculosis (PTB). CONCLUSIONS In Tuscany, tuberculosis is still a health concern in terms of both morbidity and mortality.
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Affiliation(s)
- Fiorenza Panin
- Anna Meyer Children's University Hospital, Department of Sciences for Health Sciences, University of Florence, Viale Pieraccini, 24, 50100, Florence, Italy
| | - Elisa Orlandini
- Tuscany Regional Government Department of Right to Health and Solidarity Policies, Information Technology Section, Via T. Alderotti 26/n, 50123, Florence, Italy
| | - Luisa Galli
- Anna Meyer Children's University Hospital, Department of Sciences for Health Sciences, University of Florence, Viale Pieraccini, 24, 50100, Florence, Italy
| | - Maurizio De Martino
- Anna Meyer Children's University Hospital, Department of Sciences for Health Sciences, University of Florence, Viale Pieraccini, 24, 50100, Florence, Italy
| | - Elena Chiappini
- Anna Meyer Children's University Hospital, Department of Sciences for Health Sciences, University of Florence, Viale Pieraccini, 24, 50100, Florence, Italy.
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20
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Bedingfield N, Barss L, Oxlade O, Menzies D, Fisher D. Experiences with latent TB cascade of care strengthening for household contacts in Calgary, Canada. Public Health Action 2021; 11:126-131. [PMID: 34567988 DOI: 10.5588/pha.20.0082] [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: 12/09/2020] [Accepted: 04/11/2021] [Indexed: 11/10/2022] Open
Abstract
SETTING Identification, assessment, and treatment of latent TB infection (LTBI), collectively known as the LTBI cascade of care, is critical for TB prevention. OBJECTIVE The objective of this research, conducted within the ACT4 trial, was to assess and strengthen the LTBI cascade of care for household contacts at Calgary TB Services, a clinic serving a predominately foreign-born population in Western Canada. DESIGN Baseline assessment consisted of a retrospective LTBI cascade analysis of 32 contact investigations, and questionnaires administered to patients and health care workers. Four solutions were implemented in response to identified gaps. Solution impact was measured for 6 months using descriptive statistics. RESULTS Pre-implementation, 56% of household contacts initiated treatment. Most contacts were lost to care because the tuberculin skin test (TST) was not initiated, or physicians did not recommend treatment. Evening clinics, a patient education pamphlet, a nursing workshop, and treatment recommendation guidelines were implemented. Post-implementation, losses due to LTBI treatment non-recommendation were reduced; however, the overall proportion of household contacts initiating treatment did not increase. CONCLUSION Close engagement between researchers and TB programmes can reduce losses in the LTBI cascade. To see sustained improvement in overall outcomes, long-term engagement and data collection for ongoing problem-solving are required.
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Affiliation(s)
- N Bedingfield
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary Foothills Campus, Health Sciences Centre, Calgary, AB, Canada
| | - L Barss
- Department of Medicine, Cumming School of Medicine, University of Calgary Foothills Campus, Health Sciences Centre, Calgary, AB, Canada
| | - O Oxlade
- McGill International TB Centre, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - D Menzies
- McGill International TB Centre, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - D Fisher
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary Foothills Campus, Health Sciences Centre, Calgary, AB, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary Foothills Campus, Health Sciences Centre, Calgary, AB, Canada
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21
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Moniz M, Soares P, Leite A, Nunes C. Tuberculosis amongst foreign-born and nationals: different delays, different risk factors. BMC Infect Dis 2021; 21:934. [PMID: 34496792 PMCID: PMC8427946 DOI: 10.1186/s12879-021-06635-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Delay in Tuberculosis (TB) diagnosis affects foreign-born and nationals in different ways, especially in low-incidence countries. This study characterises total delay and its components amongst foreign-born individuals in Portugal. Additionally, we identify risk factors for each type of delay and compare their effects between foreign-born and nationals. METHODS We analysed data from the Portuguese TB surveillance system and included individuals with pulmonary TB (PTB), notified between 2008 and 2017. We described patient, healthcare, and total delays. Cox regression was used to identify factors associated with each type of delay. All analyses were stratified according to the origin country: nationals (those born in Portugal) and foreign-born. RESULTS Compared with nationals, foreign-born persons presented statistically significant and longer median total and patient delays (Total: 67 vs. 63; Patient: 44 vs. 36 days), and lower healthcare services delays (7 vs. 9 days). Risk factors for delayed diagnosis differed between foreign-born and nationals. Being unemployed, having drug addiction, and having comorbidities were identified as risk factors for delayed diagnosis in national individuals but not in foreigners. Alcohol addiction was the only factor identified for healthcare delay for both populations: foreign-born (Hazard Ratio 1.34 [95% confidence interval 1.17;1.53]); nationals (Hazard Ratio 1.20 [95% confidence interval 1.13;1.27]). CONCLUSIONS Foreign-born individuals with PTB take longer to seek health care. While no specific risk factors were identified, more in-depth studies are required to identify barriers and support public health intervention to address PTB diagnosis delay in foreign-born individuals.
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Affiliation(s)
- Marta Moniz
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal. .,Comprehensive Health Research Centre (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal.
| | - Patrícia Soares
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Andreia Leite
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Carla Nunes
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal
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Scordo JM, Aguillón-Durán GP, Ayala D, Quirino-Cerrillo AP, Rodríguez-Reyna E, Joya-Ayala M, Mora-Guzmán F, Ledezma-Campos E, Villafañez A, Schlesinger LS, Torrelles JB, Turner J, Restrepo BI. Interferon Gamma Release Assays for Detection of Latent Mycobacterium tuberculosis in Elderly Hispanics. Int J Infect Dis 2021; 111:85-91. [PMID: 34389503 PMCID: PMC8540394 DOI: 10.1016/j.ijid.2021.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Interferon gamma release assays (IGRAs) are used to detect latent Mycobacterium tuberculosis (M.tb) infection (LTBI) in adults, but their performance in older people is not well-established. We evaluated IGRAs for LTBI detection in older Hispanic recent TB contacts (ReC) or community controls (CoC). Methods: Cross-sectional assessment of LTBI with T-SPOT.TB and/or QuantiFERON-Gold in-tube or –Plus assay in older (≥60 years) and adult (18–50 years) Hispanic people. Results: We enrolled 193 CoC (119 adults, 74 older persons) and 459 ReC (361 adults, 98 older persons). LTBI positivity increased with age in CoC (19%–59%, P<0.001), but was similar in ReC (59%–69%, P=0.329). Older people had lower concordance between IGRAs (kappa 0.465 vs 0.688 in adults) and more inconclusive results (indeterminate/borderline 11.6% vs 5.8% in adults, P=0.012). With simultaneous IGRAs, inconclusive results were resolved as positive or negative with the other IGRA. The magnitude of response to M.tb peptides in IGRAs was similar among age groups, but responsiveness to mitogens was lower in older people. Conclusions: IGRAs are suitable for LTBI detection in older people. Discordant and inconclusive findings are more prevalent in older people, but results are resolved when IGRA is repeated with a different IGRA test.
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Affiliation(s)
- Julia M Scordo
- Host-Pathogen Interactions and Population Health Programs, Texas Biomedical Research Institute, San Antonio, TX, USA; The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Génesis P Aguillón-Durán
- Secretaria de Salud de Tamaulipas, Reynosa 88630, Matamoros 87370 and Ciudad Victoria 87000, Tamaulipas, México
| | - Doris Ayala
- University of Texas Health Science Center at Houston, School of Public Health, Brownsville campus, Brownsville, TX 78520, USA
| | - Ana Paulina Quirino-Cerrillo
- University of Texas Health Science Center at Houston, School of Public Health, Brownsville campus, Brownsville, TX 78520, USA
| | - Eminé Rodríguez-Reyna
- Secretaria de Salud de Tamaulipas, Reynosa 88630, Matamoros 87370 and Ciudad Victoria 87000, Tamaulipas, México
| | - Mateo Joya-Ayala
- University of Texas Health Science Center at Houston, School of Public Health, Brownsville campus, Brownsville, TX 78520, USA
| | - Francisco Mora-Guzmán
- Secretaria de Salud de Tamaulipas, Reynosa 88630, Matamoros 87370 and Ciudad Victoria 87000, Tamaulipas, México
| | - Eder Ledezma-Campos
- Secretaria de Salud de Tamaulipas, Reynosa 88630, Matamoros 87370 and Ciudad Victoria 87000, Tamaulipas, México
| | - Alejandro Villafañez
- Casa Club del Adulto Mayor, Sistema para el Desarrollo Integral de la Familia, Matamoros, Tamaulipas, Mexico
| | - Larry S Schlesinger
- Host-Pathogen Interactions and Population Health Programs, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Jordi B Torrelles
- Host-Pathogen Interactions and Population Health Programs, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Joanne Turner
- Host-Pathogen Interactions and Population Health Programs, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Blanca I Restrepo
- University of Texas Health Science Center at Houston, School of Public Health, Brownsville campus, Brownsville, TX 78520, USA; School of Medicine, South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley, Edinburg, TX 78541, USA.
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23
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Parmer J, Macario E, Tatum K, Brackett A, Allen L, Picard R, DeLuca N, Dowling M. Latent tuberculosis infection: Misperceptions among non-U.S.-born-populations from countries where tuberculosis is common. Glob Public Health 2021; 17:1728-1742. [PMID: 34228584 PMCID: PMC8733044 DOI: 10.1080/17441692.2021.1947342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ABSTRACTThe Centers for Disease Control and Prevention works to eliminate tuberculosis (TB) disease by finding and treating cases of TB disease and expanding latent tuberculosis infection (LTBI) testing and treatment to prevent TB disease. Approximately 70% of reported TB cases in the United States occur among non-U.S.-born persons. We conducted 15 focus groups with U.S. residents born in the six most common countries of birth among non-U.S.-born TB patients: Mexico, the Philippines, India, Vietnam, China and Guatemala. Participants reacted to 39 messages on LTBI and TB disease risk factors, the Bacille Calmette-Guérin (BCG) vaccine, and LTBI testing and treatment. There was low awareness of LTBI, the TB blood test, and how the TB blood test is not affected by prior BCG vaccination. Several participants thought TB disease is contracted by sharing kitchenware. Some felt negatively targeted when presented with information about countries where TB disease is more common than the U.S. Findings highlight the need for communication aimed at increasing LTBI testing and treatment to include messages framed in ways that will be resonant and actionable to populations at risk. Focus groups revealed LTBI misconceptions which highlight areas for targeted education to decrease TB stigma and increase LTBI testing and treatment.
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Affiliation(s)
- John Parmer
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Katharine Tatum
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Department of Sociology, Emory University, Atlanta, GA, USA.,Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, USA
| | | | - Leeanna Allen
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Nick DeLuca
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Molly Dowling
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA
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24
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Robsky KO, Isooba D, Nakasolya O, Mukiibi J, Nalutaaya A, Kitonsa PJ, Kamoga C, Baik Y, Kendall EA, Katamba A, Dowdy DW. Characterization of geographic mobility among participants in facility- and community-based tuberculosis case finding in urban Uganda. PLoS One 2021; 16:e0251806. [PMID: 33989343 PMCID: PMC8121348 DOI: 10.1371/journal.pone.0251806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/03/2021] [Indexed: 11/18/2022] Open
Abstract
Background International and internal migration are recognized risk factors for tuberculosis (TB). Geographic mobility, including travel for work, education, or personal reasons, may also play a role in TB transmission, but this relationship is poorly defined. We aimed to define geographic mobility among participants in facility- and community-based TB case finding in Kampala, Uganda, and to assess associations between mobility, access to care, and TB disease. Methods We included consecutive individuals age ≥15 years diagnosed with TB disease through either routine health facility practices or community-based case finding (consisting of door-to-door testing, venue-based screening, and contact investigation). Each case was matched with one (for community-based enrollment) or two (health facility enrollment) TB-negative controls. We conducted a latent class analysis (LCA) of eight self-reported characteristics to identify and define mobility; we selected the best-fit model using Bayesian Information Criterion. We assessed associations between mobility and TB case status using multivariable conditional logistic regression. Results We enrolled 267 cases and 432 controls. Cases were more likely than controls to have been born in Kampala (p<0.001); there was no difference between cases and controls for remaining mobility characteristics. We selected a two-class LCA model; the “mobile” class was perfectly correlated with a single variable: travel (>3 km) from residence ≥2 times per month. Mobility was associated with a 28% reduction in odds of being a TB case (adjusted matched odds ratio 0.72 [95% confidence interval 0.49, 1.06]). Conclusion Frequency of out-of-neighborhood travel is an easily measured variable that correlates closely with predicted mobility class membership. Mobility was associated with decreased risk of TB disease; this may be in part due to the higher socioeconomic status of mobile individuals in this population. However, more research is needed to improve assessment of mobility and understand how mobility affects disease risk and transmission.
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Affiliation(s)
- Katherine O. Robsky
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- * E-mail:
| | - David Isooba
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Olga Nakasolya
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - James Mukiibi
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Annet Nalutaaya
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Peter J. Kitonsa
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Caleb Kamoga
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Yeonsoo Baik
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Emily A. Kendall
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Achilles Katamba
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Department of Medicine, Clinical Epidemiology and Biostatistics Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - David W. Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
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25
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Jackson S, Kabir Z, Comiskey C. Effects of migration on tuberculosis epidemiological indicators in low and medium tuberculosis incidence countries: A systematic review. J Clin Tuberc Other Mycobact Dis 2021; 23:100225. [PMID: 33681478 PMCID: PMC7930366 DOI: 10.1016/j.jctube.2021.100225] [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] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) remains one of the top ten causes of death each year globally. While the risk of migrant TB is linked to the TB incidence in their country of origin, the migration process can increase the TB risk. OBJECTIVE We aimed to synthesis the evidence on key differences in the epidemiological profile of TB between migrants from high TB incidence birth countries and non-migrants resident in low to medium incidence TB countries. METHODS We conducted a systematic review where the population was all active TB cases in countries with low to medium TB incidence (<40/100,000 population), the exposure was migration to a low or medium TB incidence country and the comparator was non-migrant TB cases in low or medium incidence countries. Overall proportions were compared between migrants and non-migrants, using Fisher's exact test. Meta-analysis of proportions was carried out for the primary outcome (active TB) while meta-analyses of odds ratios (ORs) were performed using a random effects model for secondary outcomes; sputum-smear positivity, any first line drug resistance, multi-drug resistance (MDR), clustered cases, HIV coinfections and successful treatment. Heterogeneity was evaluated and sources were investigated using subgroup and sensitivity analysis. RESULTS Significant differences were found in the overall proportions of high TB incidence migrants and non-migrants for MDR cases, clustered cases, HIV coinfections and successful treatment, as well as a significant difference in the OR among MDR cases (3.91). CONCLUSION This review has demonstrated significant differences in key epidemiological indicators between high TB incidence migrants and non-migrants, indicating policy implications.
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Affiliation(s)
- Sarah Jackson
- School of Nursing and Midwifery, Trinity College Dublin, University of Ireland, Ireland
| | - Zubair Kabir
- School of Public Health, University College Cork, Ireland
| | - Catherine Comiskey
- School of Nursing and Midwifery, Trinity College Dublin, University of Ireland, Ireland
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26
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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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Moosazadeh M, Kheradmand M, Aarabi M, Afshari M, Parsaee M, Nezammahalleh A, Hessami A. Factors associated with delay in diagnosis among tuberculosis patients in the north of Iran. MEDICAL JOURNAL OF INDONESIA 2021. [DOI: 10.13181/mji.oa.204476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Recognizing factors that affect delay in diagnosis in patients with pulmonary tuberculosis (TB) is critical. This study aimed to identify such factors among TB patients in the north of Iran.
METHODS In this retrospective cohort study, we reviewed patient’s medical records from the TB registration system of the Health Deputy of Mazandaran University of Medical Sciences, Sari, Iran that was responsible for the TB registry in the province from 2007 to 2017. All hospitals affiliated with the university, including private hospitals, reported TB cases directly to the health deputy. Patient’s gender, age, TB smear result, TB type, imprisonment, diabetes, nationality, residence area, and drug use were considered factors of delay in diagnosis, which was defined as a delay of >30 days between symptom onset and diagnosis. Data from 3,453 patients were analyzed using the chi-square test and logistic regression models.
RESULTS The frequency of patients with delay in diagnosis was 67.7%. There was no association between delay in diagnosis and gender (p = 0.194), TB type (p = 0.140), and diabetes (p = 0.198). On the other hand, old age (≥60 years) was related to delay in diagnosis (OR = 1.37; 95% CI = 1.12–1.68; p = 0.002). The chance of delay in diagnosis in prisoners was lower than in non-prisoners (OR = 0.62; 95% CI = 0.46–0.82; p = 0.001).
CONCLUSIONS Old age was a risk factor for delay in diagnosis, and interestingly, prisoners had been diagnosed significantly faster.
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28
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Xiao W, Huang D, Li S, Zhou S, Wei X, Chen B, Zou G. Delayed diagnosis of tuberculosis in patients with diabetes mellitus co-morbidity and its associated factors in Zhejiang Province, China. BMC Infect Dis 2021; 21:272. [PMID: 33736610 PMCID: PMC7977257 DOI: 10.1186/s12879-021-05929-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 02/22/2021] [Indexed: 12/05/2022] Open
Abstract
Background Tuberculosis (TB) remains a significant global public health problem. China has the second highest TB burden in the world. With a growing TB population with diabetes mellitus (DM), the TB control system faces mounting challenges. To date, evidence remains inconclusive regarding the association between TB-DM co-morbidity and delayed diagnosis of TB patients. This study aims to assess the diagnostic delay of TB patients with known DM and identify the factors associated with this delay. Methods Data was collected from China’s Tuberculosis information management system in two counties of Zhejiang province, China. Patient delay, health system delay and total diagnostic delay are defined as follows: 1) the interval between the onset of TB symptoms and first visit to any health facility; 2) from the first visit to the health facility to the confirmed TB diagnosis in the designated hospital; 3) the sum of patient and health system’s respective delays. Comparison of these delays was made between TB patients with and without DM using Mann-Whitney U test and Chi-square test. Univariate and multivariate regression analysis was used to identify factors influencing delays among TB patients with DM. Results Of 969 TB patients, 67 (7%) TB patients had DM co-morbidity. Compared with TB patients without DM, TB patients with DM experienced significantly shorter health system delays (p < 0.05), and there was a significantly lower proportion of patients whose health system delayed> 14 days (7.0% vs. 18%, p < 0.05). However, no significant difference was observed between both patient categories regarding patient delay and total diagnostic delay. The multivariate regression analysis suggested that TB patients with DM who were aged < 60 years (AOR = 3.424, 95%CI: 1.008–11.627, p < 0.05) and non-severe cases (AOR = 9.725, 95%CI: 2.582–36.626, p < 0.05) were more likely to have a total diagnostic delay of> 14 days. Conclusions Our study suggests that DM does not contribute to further diagnostic delay as expected. Instead, we observed significantly improved health system delay among TB patients with DM. The findings indicate the importance of early screening and diagnosis for TB among diabetic patients and of strengthening the integrated control and management of TB and diabetic programs.
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Affiliation(s)
- Wenhui Xiao
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Dajiang Huang
- Center for Disease Prevention and Control, Cangnan County, Wenzhou, Zhejiang Province, China
| | - Saiqiong Li
- Center for Disease Prevention and Control, Yongjia County, Wenzhou, Zhejiang Province, China
| | - Shangcheng Zhou
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaolin Wei
- Division of Clinical Epidemiology & Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Bin Chen
- Zhejiang Provincial Center for Disease Prevention and Control, Hangzhou, China.
| | - Guanyang Zou
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China.
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29
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Perumal P, Abdullatif MB, Garlant HN, Honeyborne I, Lipman M, McHugh TD, Southern J, Breen R, Santis G, Ellappan K, Kumar SV, Belgode H, Abubakar I, Sinha S, Vasan SS, Joseph N, Kempsell KE. Validation of Differentially Expressed Immune Biomarkers in Latent and Active Tuberculosis by Real-Time PCR. Front Immunol 2021; 11:612564. [PMID: 33841389 PMCID: PMC8029985 DOI: 10.3389/fimmu.2020.612564] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/23/2020] [Indexed: 12/18/2022] Open
Abstract
Tuberculosis (TB) remains a major global threat and diagnosis of active TB ((ATB) both extra-pulmonary (EPTB), pulmonary (PTB)) and latent TB (LTBI) infection remains challenging, particularly in high-burden countries which still rely heavily on conventional methods. Although molecular diagnostic methods are available, e.g., Cepheid GeneXpert, they are not universally available in all high TB burden countries. There is intense focus on immune biomarkers for use in TB diagnosis, which could provide alternative low-cost, rapid diagnostic solutions. In our previous gene expression studies, we identified peripheral blood leukocyte (PBL) mRNA biomarkers in a non-human primate TB aerosol-challenge model. Here, we describe a study to further validate select mRNA biomarkers from this prior study in new cohorts of patients and controls, as a prerequisite for further development. Whole blood mRNA was purified from ATB patients recruited in the UK and India, LTBI and two groups of controls from the UK (i) a low TB incidence region (CNTRLA) and (ii) individuals variably-domiciled in the UK and Asia ((CNTRLB), the latter TB high incidence regions). Seventy-two mRNA biomarker gene targets were analyzed by qPCR using the Roche Lightcycler 480 qPCR platform and data analyzed using GeneSpring™ 14.9 bioinformatics software. Differential expression of fifty-three biomarkers was confirmed between MTB infected, LTBI groups and controls, seventeen of which were significant using analysis of variance (ANOVA): CALCOCO2, CD52, GBP1, GBP2, GBP5, HLA-B, IFIT3, IFITM3, IRF1, LOC400759 (GBP1P1), NCF1C, PF4V1, SAMD9L, S100A11, TAF10, TAPBP, and TRIM25. These were analyzed using receiver operating characteristic (ROC) curve analysis. Single biomarkers and biomarker combinations were further assessed using simple arithmetic algorithms. Minimal combination biomarker panels were delineated for primary diagnosis of ATB (both PTB and EPTB), LTBI and identifying LTBI individuals at high risk of progression which showed good performance characteristics. These were assessed for suitability for progression against the standards for new TB diagnostic tests delineated in the published World Health Organization (WHO) technology product profiles (TPPs).
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Affiliation(s)
- Prem Perumal
- Public Health England, Porton Down, Salisbury, Wiltshire, United Kingdom
| | | | - Harriet N. Garlant
- Public Health England, Porton Down, Salisbury, Wiltshire, United Kingdom
| | - Isobella Honeyborne
- Centre for Clinical Microbiology, University College London, Royal Free Campus, London, United Kingdom
| | - Marc Lipman
- UCL Respiratory, University College London, Royal Free Campus, London, United Kingdom
| | - Timothy D. McHugh
- Centre for Clinical Microbiology, University College London, Royal Free Campus, London, United Kingdom
| | - Jo Southern
- Institute for Global Health, University College London, London, United Kingdom
| | - Ronan Breen
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - George Santis
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Kalaiarasan Ellappan
- Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Gorimedu, Puducherry, India
| | - Saka Vinod Kumar
- Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Gorimedu, Puducherry, India
| | - Harish Belgode
- Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Gorimedu, Puducherry, India
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, United Kingdom
| | - Sanjeev Sinha
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Seshadri S. Vasan
- Public Health England, Porton Down, Salisbury, Wiltshire, United Kingdom
- Department of Health Sciences, University of York, York, United Kingdom
| | - Noyal Joseph
- Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Gorimedu, Puducherry, India
| | - Karen E. Kempsell
- Public Health England, Porton Down, Salisbury, Wiltshire, United Kingdom
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30
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Khan FU, Asghar Z, Tipu MK, Rehman AU, Khan A, Ur-Rehman T. Effect of Displacement on Adherence to TB Treatment: An Observational Study in TB Patients from Internally Displaced Persons of Pakistan. Pak J Med Sci 2021; 37:675-679. [PMID: 34104146 PMCID: PMC8155409 DOI: 10.12669/pjms.37.3.2992] [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] [Indexed: 11/22/2022] Open
Abstract
Objective: This study was aimed to investigate TB patients adherence and treatment outcomes among internally displaced patients in comparison with adjacent settled areas. Methods: The study was designed as an observational cross-sectional study among the TB patients of internally displaced populations (IDPs) of North Waziristan Agency (NWA) and adjacent settled areas of Bannu and Lakki Marwat (NIDPs). Based on the study inclusion and exclusion criteria 330 patients fullfilled the inclusion criteria and were assigned equally to both IDPs and NIDPs study groups. Odds ratio (OR) with 95% confidence interval was calculated and p-values, 0.05 were considered statistically significant. Results: The treatment outcomes with the status of “cured” and “completed treatment” were better among NIDPs as compared to IDPs. Patients with treatment outcome status of “defaulted treatment”, “without documentary evidence, and “failure” were high in IDPs as compared to NIDPs. Adherence to TB treatment was better among NIDPs (50.9%) as compared to IDPs (39.4%). The patients showing non-adherence to TB treatment were more among IDPS (27.3%) than NIDPs (10.9%). Conclusion: Overall results of this study revealed a poor adherence to the TB treatment medications with an odds ratio of 0.286, (p<0.05) among IDPs as compared with NIDPs.
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Affiliation(s)
- Farman Ullah Khan
- Farman Ullah Khan, Department of Pharmacy, Faculty of Biological Science, Quaid-i-Azam University, 45320 Islamabad, Pakistan
| | - Zahid Asghar
- Zahid Asghar, School of Economics, Faculty of Social Sciences, Quaid-i-Azam University, 45320 Islamabad, Pakistan
| | - Muhammad Khalid Tipu
- Muhammad Khalid Tipu, Department of Pharmacy, Faculty of Biological Science, Quaid-i-Azam University, 45320 Islamabad, Pakistan
| | - Asim Ur Rehman
- Asim.ur.Rehman, Department of Pharmacy, Faculty of Biological Science, Quaid-i-Azam University, 45320 Islamabad, Pakistan
| | - Asif Khan
- Asif Khan, District TB Control Program, Bannu, 28100 Khyber PakhtunKhwa, Pakistan
| | - Tofeeq Ur-Rehman
- Tofeeq Ur-Rehman, Department of Pharmacy, Faculty of Biological Science, Quaid-i-Azam University, 45320 Islamabad, Pakistan
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31
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Kwak R, Kamal K, Charrow A, Khalifian S. Mass migration and climate change: Dermatologic manifestations. Int J Womens Dermatol 2021; 7:98-106. [PMID: 33537399 PMCID: PMC7838242 DOI: 10.1016/j.ijwd.2020.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 12/26/2022] Open
Abstract
Major changes in climate resulting in mass migrations have unique dermatologic implications for global vulnerable populations. Dermatologic manifestations commonly accompany the infectious and communicable diseases that proliferate in the settings of confinement, crowding, and limited sanitation associated with mass migration. Ectoparasitic infestations abound in refugee camps, and poor nutrition, hygiene, and compromised immunity put refugees at an increased risk for more dangerous infectious diseases carried by these ectoparasites. Climate change also profoundly affects the worldwide distribution of various vector-borne illnesses, thereby leading to the emergence of various communicable diseases in previously nonendemic areas. Natural disasters not only disrupt important lifesaving treatments, but also challenge various infectious disease control measures that are critical in preventing rapid transmission of highly infectious diseases. This article reviews the infectious diseases commonly found in these scenarios and provides an in-depth discussion of important implications for the dermatologist.
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Affiliation(s)
- Ruby Kwak
- Department of Dermatology, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Kanika Kamal
- Department of Dermatology, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Alexandra Charrow
- Department of Dermatology, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Saami Khalifian
- Department of Medicine, Division of Dermatology, University of California Los Angeles, Los Angeles, CA, United States
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Health assessment for migrants and asylum seekers upon arrival and while hosted in reception centres: Italian guidelines. Health Policy 2020; 125:393-405. [PMID: 33461797 DOI: 10.1016/j.healthpol.2020.12.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND During 2016-17, national guidelines were developed in order to provide evidence-based recommendations on health assessments for migrants and asylum seekers upon their arrival in Italy. METHODS Scientific literature published between 2005 and 2016 was searched in different databases. A free search was also performed on international organizations' websites in order to identify additional relevant documents. A multidisciplinary panel discussed the resulting evidence and formulated recommendations. RESULTS Evidence-based recommendations were formulated: signs and symptoms of specific diseases should to be actively searched for active TB, malaria, STI, intestinal parasites, diabetes, anaemia. In case of other health conditions (latent TB, HIV, HBV, HCV, STI, strongyloides, schistosoma, diabetes), testing should be offered to asymptomatic subjects coming from endemic areas or exposed to risk factors. Mass screening is recommended for anaemia and hypertension; a pregnancy test should be considered, while inclusion in cervical cancer screening and vaccination programs is recommended. A modulated, progressive approach was developed, covering an initial evaluation during rescue operations, a full medical examination at first line reception stage and the referral to national health services during second line reception. CONCLUSIONS It is important to produce and periodically update guidelines on these issues and local peculiarities should be taken into account in their design and implementation. Guidelines can not only support economic sustainability, but also counteract stigmatization dynamics.
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Vo LNQ, Codlin AJ, Forse RJ, Nguyen NT, Vu TN, Le GT, Van Truong V, Do GC, Dang HM, Nguyen LH, Nguyen HB, Nguyen NV, Levy J, Lonnroth K, Squire SB, Caws M. Evaluating the yield of systematic screening for tuberculosis among three priority groups in Ho Chi Minh City, Viet Nam. Infect Dis Poverty 2020; 9:166. [PMID: 33292638 PMCID: PMC7724701 DOI: 10.1186/s40249-020-00766-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/15/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND In order to end tuberculosis (TB), it is necessary to expand coverage of TB care services, including systematic screening initiatives. However, more evidence is needed for groups among whom systematic screening is only conditionally recommended by the World Health Organization. This study evaluated concurrent screening in multiple target groups using community health workers (CHW). METHODS In our two-year intervention study lasting from October 2017 to September 2019, CHWs in six districts of Ho Chi Minh City, Viet Nam verbally screened three urban priority groups: (1) household TB contacts; (2) close TB contacts; and (3) residents of urban priority areas without clear documented exposure to TB including hotspots, boarding homes and urban slums. Eligible persons were referred for further screening with chest radiography and follow-on testing with the Xpert MTB/RIF assay. Symptomatic individuals with normal or without radiography results were tested on smear microscopy. We described the TB care cascade and characteristics for each priority group, and calculated yield and number needed to screen. Subsequently, we fitted a mixed-effect logistic regression to identify the association of these target groups and secondary patient covariates with TB treatment initiation. RESULTS We verbally screened 321 020 people including 24 232 household contacts, 3182 social and close contacts and 293 606 residents of urban priority areas. This resulted in 1138 persons treated for TB, of whom 85 were household contacts, 39 were close contacts and 1014 belonged to urban priority area residents. The yield of active TB in these groups was 351, 1226 and 345 per 100 000, respectively, corresponding to numbers needed to screen of 285, 82 and 290. The fitted model showed that close contacts [adjusted odds ratio (aOR) = 2.07; 95% CI: 1.38-3.11; P < 0.001] and urban priority area residents (aOR = 2.18; 95% CI: 1.69-2.79; P < 0.001) had a greater risk of active TB than household contacts. CONCLUSIONS The study detected a large number of unreached persons with TB, but most of them were not among persons in contact with an index patient. Therefore, while programs should continue to optimize screening in contacts, to close the detection gap in high TB burden settings such as Viet Nam, coverage must be expanded to persons without documented exposure such as residents in hotspots, boarding homes and urban slums.
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Affiliation(s)
- Luan Nguyen Quang Vo
- Friends for International TB Relief, 68B Nguyen Van Troi, 8, Phu Nhuan, Ho Chi Minh City, Viet Nam.
- Interactive Research and Development, Ho Chi Minh City, Viet Nam.
| | - Andrew James Codlin
- Friends for International TB Relief, 68B Nguyen Van Troi, 8, Phu Nhuan, Ho Chi Minh City, Viet Nam
| | - Rachel Jeanette Forse
- Friends for International TB Relief, 68B Nguyen Van Troi, 8, Phu Nhuan, Ho Chi Minh City, Viet Nam
| | - Nga Thuy Nguyen
- Friends for International TB Relief, 68B Nguyen Van Troi, 8, Phu Nhuan, Ho Chi Minh City, Viet Nam
| | - Thanh Nguyen Vu
- Ho Chi Minh City Public Health Association, Ho Chi Minh City, Viet Nam
| | - Giang Truong Le
- Ho Chi Minh City Public Health Association, Ho Chi Minh City, Viet Nam
| | | | - Giang Chau Do
- Pham Ngoc Thach Hospital, Ho Chi Minh City, Viet Nam
| | - Ha Minh Dang
- Pham Ngoc Thach Hospital, Ho Chi Minh City, Viet Nam
| | | | | | | | - Jens Levy
- KNCV Tuberculosefonds, The Hague, The Netherlands
| | - Knut Lonnroth
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - S Bertel Squire
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Maxine Caws
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Birat Nepal Medical Trust, Lazimpat, Kathmandu, Nepal
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Degeling C, Carter SM, Dale K, Singh K, Watts K, Hall J, Denholm J. Perspectives of Vietnamese, Sudanese and South Sudanese immigrants on targeting migrant communities for latent tuberculosis screening and treatment in low-incidence settings: A report on two Victorian community panels. Health Expect 2020; 23:1431-1440. [PMID: 32918523 PMCID: PMC7752196 DOI: 10.1111/hex.13121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/15/2020] [Accepted: 07/21/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) elimination strategies in Australia require a focus on groups who are at highest risk of TB infection, such as immigrants from high-burden settings. Understanding attitudes to different strategies for latent TB infection (LTBI) screening and treatment is an important element of justifiable elimination strategies. METHOD Two community panels were conducted in Melbourne with members of the Vietnamese (n = 11), Sudanese and South Sudanese communities (n = 9). Panellists were provided with expert information about LTBI and different screening and health communication strategies, then deliberated on how best to pursue TB elimination in Australia. FINDINGS Both panels unanimously preferred LTBI screening to occur pre-migration rather than in Australia. Participants were concerned that post-migration screening would reach fewer migrants, noted that conducting LTBI screening in Australia could stigmatize participants and that poor awareness of LTBI would hamper participation. If targeted screening was to occur in Australia, the Vietnamese panel preferred 'place-based' communication strategies, whereas the Sudanese and South Sudanese panel emphasized that community leaders should lead communication strategies to minimize stigma. Both groups emphasized the importance of maintaining community trust in Australian health service providers, and the need to ensure targeting did not undermine this trust. CONCLUSION Pre-migration screening was preferred. If post-migration screening is necessary, the potential for stigma should be reduced, benefit and risk profile clearly explained and culturally appropriate communication strategies employed. Cultural attitudes to health providers, personal health management and broader social vulnerabilities of targeted groups need to be considered in the design of screening programs.
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Affiliation(s)
- Chris Degeling
- Australian Centre for Health Engagement Evidence and ValuesSchool of Health & SocietyUniversity of WollongongWollongongNSWAustralia
| | - Stacy M. Carter
- Australian Centre for Health Engagement Evidence and ValuesSchool of Health & SocietyUniversity of WollongongWollongongNSWAustralia
| | - Katie Dale
- Victorian Tuberculosis ProgramMelbourne Health at The Doherty Institute for Infection & ImmunityMelbourneVICAustralia
- Department of Microbiology and ImmunologyUniversity of MelbourneMelbourneVICAustralia
| | - Kasha Singh
- Victorian Infectious Diseases ServiceMelbourne Health at The Doherty Institute for Infection & ImmunityMelbourneVICAustralia
| | - Krista Watts
- Victorian Tuberculosis ProgramMelbourne Health at The Doherty Institute for Infection & ImmunityMelbourneVICAustralia
| | - Julie Hall
- Australian Centre for Health Engagement Evidence and ValuesSchool of Health & SocietyUniversity of WollongongWollongongNSWAustralia
| | - Justin Denholm
- Victorian Tuberculosis ProgramMelbourne Health at The Doherty Institute for Infection & ImmunityMelbourneVICAustralia
- Department of Microbiology and ImmunologyUniversity of MelbourneMelbourneVICAustralia
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Knowledge, attitudes, beliefs, and stigma related to latent tuberculosis infection: a qualitative study among Eritreans in the Netherlands. BMC Public Health 2020; 20:1602. [PMID: 33097021 PMCID: PMC7585221 DOI: 10.1186/s12889-020-09697-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 10/14/2020] [Indexed: 11/12/2022] Open
Abstract
Background Tailored and culturally appropriate latent tuberculosis (TB) infection screening and treatment programs, including interventions against TB stigma, are needed to reduce TB incidence in low TB incidence countries. However, we lack insights in stigma related to latent TB infection (LTBI) among target groups, such as asylum seekers and refugees. We therefore studied knowledge, attitudes, beliefs, and stigma associated with LTBI among Eritrean asylum seekers and refugees in the Netherlands. Methods We used convenience sampling to interview adult Eritrean asylum seekers and refugees: 26 semi-structured group interviews following TB and LTBI related health education and LTBI screening, and 31 semi-structured individual interviews with Eritreans during or after completion of LTBI treatment (November 2016–May 2018). We used a thematic analysis to identify, analyse and report patterns in the data. Results Despite TB/LTBI education, misconceptions embedded in cultural beliefs about TB transmission and prevention persisted. Fear of getting infected with TB was the cause of reported enacted (isolation and gossip) and anticipated (concealment of treatment and self-isolation) stigma by participants on LTBI treatment. Conclusion The inability to differentiate LTBI from TB disease and consequent fear of getting infected by persons with LTBI led to enacted and anticipated stigma comparable to stigma related to TB disease among Eritreans. Additional to continuous culturally sensitive education activities, TB prevention programs should implement evidence-based interventions reducing stigma at all phases in the LTBI screening and treatment cascade. Supplementary information Supplementary information accompanies this paper at 10.1186/s12889-020-09697-z.
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Valenzuela-Soltero DM, Güereca-Alvarado JA, Pacheco-Barajas M, Sánchez-Rebollar N, Laniado-Laborín R. Early Hospital Readmission in Patients With Tuberculosis: Social and Cultural Risk Factors. CURRENT RESPIRATORY MEDICINE REVIEWS 2020. [DOI: 10.2174/1573398x16999200531170451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Few studies have focused on risk factors for early readmission in patients
with tuberculosis.
Objective:
Determine what are the risk factors for the early readmission of patients with tuberculosis
at General Tijuana Hospital, Mexico.
Material and methods:
All patients aged ≥ 18 years who were admitted with the confirmed
diagnosis of pulmonary tuberculosis were prospectively included. Information was obtained on
demographic, socioeconomic variables, previous hospitalizations, clinical data, and laboratory and
radiographic studies.
Results:
One hundred and thirty-four patients with tuberculosis were included, and 24 of them
(17.9%) corresponded to early hospital readmissions. The interval between initial admission and
readmission was 1.45 ± 0.183 months. The readmission group had used illicit drugs for more years
(11.3 ± 13.9 years) than the new cases group (8.01 ± 8.25 years; p = 0.03). Forty percent of the
patients who were readmitted did not go to their referral health unit after their initial hospital
discharge. The reasons argued by the patients included, among others, not having received
information regarding their illness during hospitalization, the abuse of illegal substances and the
perception of hostility by health personnel.
Discussion:
One out of every five patients admitted for tuberculosis will be readmitted after only six
weeks of initial discharge. Sociocultural factors (addictions, comorbidities, poverty) and of the health
system (limited hours of medical care, accessibility) contribute to this phenomenon.
Conclusions:
Loss of follow-up after hospital discharge is common in most settings and contributes to
an increase in morbidity and mortality, and transmission of infection in the community.
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Affiliation(s)
| | | | | | | | - Rafael Laniado-Laborín
- ClInica y Laboratorio de Tuberculosis, Hospital General Tijuana, ISESALUD, Tijuana, Mexico
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Scandurra G, Degeling C, Douglas P, Dobler CC, Marais B. Tuberculosis in migrants - screening, surveillance and ethics. Pneumonia (Nathan) 2020; 12:9. [PMID: 32923311 PMCID: PMC7473829 DOI: 10.1186/s41479-020-00072-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 07/29/2020] [Indexed: 12/13/2022] Open
Abstract
Tuberculosis (TB) is the leading infectious cause of human mortality and is responsible for nearly 2 million deaths every year. It is often regarded as a 'silent killer' because it predominantly affects the poor and marginalized, and disease outbreaks occur in 'slow motion' compared to Ebola or coronavirus 2 (COVID-19). In low incidence countries, TB is predominantly an imported disease and TB control in migrants is pivotal for countries to progress towards TB elimination in accordance with the World Health Organisations (WHO's) End TB strategy. This review provides a brief overview of the different screening approaches and surveillance processes that are in place in low TB incidence countries. It also includes a detailed discussion of the ethical issues related to TB screening of migrants in these settings and the different interests that need to be balanced. Given recognition that a holistic approach that recognizes and respects basic human rights is required to end TB, the review considers the complexities that require consideration in low-incidence countries that are aiming for TB elimination.
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Affiliation(s)
- Gabriella Scandurra
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, Australia
| | - Chris Degeling
- Australian Centre for Health Engagement Evidence and Values, University of Wollongong, Wollongong, Australia
| | - Paul Douglas
- International Organization for Migration (IOM), Geneva, Switzerland
| | - Claudia C. Dobler
- Institute for Evidenced-Based Healthcare, Bond University, Gold Coast, Australia
| | - Ben Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, Australia
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Cooper CL, Read D, Vachon ML, Conway B, Wong A, Ramji A, Borgia S, Tam E, Barrett L, Smyth D, Feld JJ, Lee S. Hepatitis C virus infection characteristics and treatment outcomes in Canadian immigrants. BMC Public Health 2020; 20:1345. [PMID: 32883249 PMCID: PMC7469277 DOI: 10.1186/s12889-020-09464-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/27/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND There are multiple obstacles encountered by immigrants attempting to engage hepatitis C virus (HCV) care and treatment. We evaluated the diversity and treatment outcomes of HCV-infected immigrants evaluated for Direct Acting Antiviral (DAA) therapy in Canada. METHODS The Canadian Network Undertaking against Hepatitis C (CANUHC) Cohort contains demographic information and DAA treatment information prospectively collected at 10 Canadian sites. Information on country of origin and race are collected. Characteristics and outcomes (sustained virological response; SVR) were compared by immigration status and race. RESULTS Between January 2016 and May 2018, 725 HCV-infected patients assessed for DAA therapy were enrolled in CANUHC (mean age: 52.66 ± 12.68 years); 65.66% male; 82.08% White, 5.28% Indigenous, 4.64% South East Asian, 4.64% East Indian, 3.36% Black). 18.48% were born outside of Canada. Mean age was similar [immigrants: 54.36 ± 13.95 years), Canadian-born: 52.27 ± 12.35 years); (p = 0.085)]. The overall baseline fibrosis score (in kPa measured by transient elastography) was similar among Canadian and foreign-born patients. Fibrosis score was not predicted by race or genotype. The proportion initiating DAA therapy was similar by immigrant status (56.72% vs 49.92%). SVR rates by intent-to-treat analysis were similar (immigrants-89.47%, Canadian-born-92.52%; p = 0.575). CONCLUSION A diverse immigrant population is engaging care in Canada, initiating HCV antiviral therapy in an equitable fashion and achieving SVR proportions similar to Canada-born patients. Our Canadian experience may be of value in informing HCV elimination efforts in economically developed regions.
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Affiliation(s)
- Curtis L Cooper
- University of Ottawa, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON, K1H 8M5, Canada.
- University of Ottawa, The Ottawa Hospital-General Campus, G12-501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada.
| | - Daniel Read
- University of Ottawa, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON, K1H 8M5, Canada
| | - Marie-Louise Vachon
- Laval University, Ferdinand Vandry Pavillon, 1050 Avenue de la Médecine, Quebec City, Quebec, G1V 0A6, Canada
| | - Brian Conway
- Vancouver Infectious Diseases Centre, 1200 Burrard St, Vancouver, BC, V6Z 2C7, Canada
| | - Alexander Wong
- University of Saskatchewan, 107 Wiggins Rd, Saskatoon, SK, S7N 5E5, Canada
| | - Alnoor Ramji
- University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Sergio Borgia
- McMaster University, Michael DeGroote Centre for Learning and Discovery (MDCL) - 3104, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Ed Tam
- Liver Health Centre, 750 W Broadway, Vancouver, BC, V5Z 1H2, Canada
| | - Lisa Barrett
- Dalhousie University, 5849 University Ave, Halifax, NS, B3H 4R2, Canada
| | - Dan Smyth
- Dalhousie University, 5849 University Ave, Halifax, NS, B3H 4R2, Canada
| | - Jordan J Feld
- Toronto General Hospital Research Institute, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - Sam Lee
- Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
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Ronchetto M, Ronchetto F. Social, cultural and political aspects concerning tuberculosis and its persistence in the world and within societies. An overview. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2019. [DOI: 10.23736/s0393-3660.18.03932-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Gulliford M, Garner-Purkis A. Tuberculosis testing and migrant health. THE LANCET. INFECTIOUS DISEASES 2019; 19:1151-1152. [PMID: 31471130 DOI: 10.1016/s1473-3099(19)30314-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 06/04/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Martin Gulliford
- School of Population Health and Environmental Sciences, King's College London, London, SE1 1UL, UK.
| | - Aphra Garner-Purkis
- School of Population Health and Environmental Sciences, King's College London, London, SE1 1UL, UK
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Tuberculosis Prevalence Among US Crop-Workers, 2000 to 2012: Trends and Contributing Factors. J Occup Environ Med 2019; 60:603-611. [PMID: 29271838 DOI: 10.1097/jom.0000000000001257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE We intend to study tuberculosis (TB) in one of the poorest communities in the US, hired agriculture workers, for most recent years (2000 to 2012) including the last recession period. METHODS Time-chart, simple mean differences, and logistic regressions were used to describe TB-prevalence and risk factors among US crop-workers. Data were drawn from the National Agricultural Workers Survey (NAWS). RESULTS A high TB-prevalence was found among crop-workers with a dramatically increasing trend in recent years. Hispanic ethnicity, having farmworker family members, the presence of health insurance, and good spoken English were associated with an increased TB-prevalence. CONCLUSION We found risk factors related to ethnicity and poor access to health care, a strong association between agriculture activity and TB, and an increase of TB-cases due to the 2008 downturn in this underserved population. We urge the health authorities to control this epidemic.
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Greenaway C, Pareek M, Abou Chakra CN, Walji M, Makarenko I, Alabdulkarim B, Hogan C, McConnell T, Scarfo B, Christensen R, Tran A, Rowbotham N, van der Werf MJ, Noori T, Pottie K, Matteelli A, Zenner D, Morton RL. The effectiveness and cost-effectiveness of screening for latent tuberculosis among migrants in the EU/EEA: a systematic review. ACTA ACUST UNITED AC 2019; 23. [PMID: 29637889 PMCID: PMC5894253 DOI: 10.2807/1560-7917.es.2018.23.14.17-00543] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Migrants account for a large and growing proportion of tuberculosis (TB) cases in low-incidence countries in the European Union/European Economic Area (EU/EEA) which are primarily due to reactivation of latent TB infection (LTBI). Addressing LTBI among migrants will be critical to achieve TB elimination. Methods: We conducted a systematic review to determine effectiveness (performance of diagnostic tests, efficacy of treatment, uptake and completion of screening and treatment) and a second systematic review on cost-effectiveness of LTBI screening programmes for migrants living in the EU/EEA. Results: We identified seven systematic reviews and 16 individual studies that addressed our aims. Tuberculin skin tests and interferon gamma release assays had high sensitivity (79%) but when positive, both tests poorly predicted the development of active TB (incidence rate ratio: 2.07 and 2.40, respectively). Different LTBI treatment regimens had low to moderate efficacy but were equivalent in preventing active TB. Rifampicin-based regimens may be preferred because of lower hepatotoxicity (risk ratio = 0.15) and higher completion rates (82% vs 69%) compared with isoniazid. Only 14.3% of migrants eligible for screening completed treatment because of losses along all steps of the LTBI care cascade. Limited economic analyses suggest that the most cost-effective approach may be targeting young migrants from high TB incidence countries. Discussion: The effectiveness of LTBI programmes is limited by the large pool of migrants with LTBI, poorly predictive tests, long treatments and a weak care cascade. Targeted LTBI programmes that ensure high screening uptake and treatment completion will have greatest individual and public health benefit.
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Affiliation(s)
- Christina Greenaway
- Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada.,Division of Infectious Diseases, Jewish General Hospital, McGill University, Montreal, Canada
| | - Manish Pareek
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom
| | | | - Moneeza Walji
- Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Iuliia Makarenko
- Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Balqis Alabdulkarim
- Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Catherine Hogan
- Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada.,Division of Infectious Diseases, Jewish General Hospital, McGill University, Montreal, Canada
| | - Ted McConnell
- Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Brittany Scarfo
- Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Robin Christensen
- Department of Rheumatology, Odense University Hospital, Denmark.,Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Anh Tran
- National Health and Medical Research Council, NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Nick Rowbotham
- National Health and Medical Research Council, NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | | | - Teymur Noori
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Kevin Pottie
- Bruyere Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Alberto Matteelli
- Clinic of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, World Health Organization Collaborating Centre for TB/HIV and TB Elimination, Brescia, Italy
| | - Dominik Zenner
- Department of Infection and Population Health, University College London, London, United Kingdom.,Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom
| | - Rachael L Morton
- National Health and Medical Research Council, NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
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Spruijt I, Tesfay Haile D, Suurmond J, van den Hof S, Koenders M, Kouw P, van Noort N, Toumanian S, Cobelens F, Goosen S, Erkens C. Latent tuberculosis screening and treatment among asylum seekers: a mixed-methods study. Eur Respir J 2019; 54:13993003.00861-2019. [DOI: 10.1183/13993003.00861-2019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/26/2019] [Indexed: 11/05/2022]
Abstract
IntroductionEvidence on conditions for implementation of latent tuberculosis infection (LTBI) screening and treatment among asylum seekers is needed to inform tuberculosis (TB) control policies. We used mixed-methods to evaluate the implementation of an LTBI screening and treatment programme among asylum seekers in the Netherlands.MethodsWe offered voluntary LTBI screening to asylum seekers aged ≥12 years living in asylum seeker centres from countries with a TB incidence >200 per 10 000 population. We calculated LTBI screening and treatment cascade coverage, and assessed associated factors with Poisson regression using robust variance estimators. We interviewed TB care staff (seven group interviews) and Eritrean clients (21 group and 21 individual interviews) to identify programme enhancers and barriers.ResultsWe screened 719 (63% of 1136) clients for LTBI. LTBI was diagnosed among 178 (25%) clients; 149 (84%) initiated LTBI treatment, of whom 129 (87%) completed treatment. In-person TB and LTBI education, the use of professional interpreters, and collaboration with partner organisations were enhancers for LTBI screening uptake. Demand-driven LTBI treatment support by TB nurses enhanced treatment completion. Factors complicating LTBI screening and treatment were having to travel to public health services, language barriers and moving from asylum seeker centres to the community during treatment.ConclusionLTBI screening and treatment of asylum seekers is feasible and effective when high quality of care is provided, including culture-sensitive TB education throughout the care cascade. Additionally, collaboration with partner organisations, such as agencies responsible for reception and support of asylum seekers, should be in place.
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Humphreys CE, Lee A, Offer C, Spencer-Henshall R, Okereke E. A qualitative study exploring awareness and attitudes towards tuberculosis in migrant populations in a Metropolitan District Council in the North of England. J Public Health (Oxf) 2019. [PMID: 28633509 DOI: 10.1093/pubmed/fdx061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The majority of tuberculosis (TB) cases in the UK occur among people born in high-burden countries (73%), and are concentrated in large urban centres. This study explores migrants' attitudes and beliefs towards TB in an English District where the incidence is higher than the UK average. Methods Community engagement workers ran 26 focus groups using a standardized questionnaire. Purposeful sampling was used to obtain a cross-section of migrant communities. The summary reports were analysed using thematic analysis. Results Most groups did not see TB as a current issue in their community and associated it either with the past or with their country of birth. It appeared to be rarely discussed in their communities and generally not noted as being associated with stigma. Conclusions This study revealed a change in social attitudes to TB in migrant groups to those reported in previous literature. Stigma had considerably less effect than expected. However, the evidence revealed that these high-risk groups made the erroneous assumption that, by moving to a low incidence country, they were no longer at risk of the disease. TB services need to respond by revising the information that they provide to take into account the risk perception of these populations.
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Affiliation(s)
- C E Humphreys
- Public Health England South East, Chilton OX11 0RQ, UK
| | - A Lee
- Public Health England, Blenheim House, Duncombe Street, Leeds LS1 4PL, UK
- The School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - C Offer
- Wakefield Metropolitan District Council, Wakefield One, Burton Street, Wakefield WF1 2EB, UK
| | - R Spencer-Henshall
- Kirklees Council, Civic Centre 3, Market Street, Huddersfield HD1 2TG, UK
| | - E Okereke
- Public Health England, Wellington House, Waterloo Road, London SE1 8UG, UK
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Ronald LA, Campbell JR, Balshaw RF, Romanowski K, Roth DZ, Marra F, Cook VJ, Johnston JC. Demographic predictors of active tuberculosis in people migrating to British Columbia, Canada: a retrospective cohort study. CMAJ 2019; 190:E209-E216. [PMID: 29483329 DOI: 10.1503/cmaj.170817] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Canadian tuberculosis (TB) guidelines recommend targeting postlanding screening for and treatment of latent tuberculosis infection (LTBI) in people migrating to Canada who are at increased risk for TB reactivation. Our objectives were to calculate robust longitudinal estimates of TB incidence in a cohort of people migrating to British Columbia, Canada, over a 29-year period, and to identify groups at highest risk of developing TB based on demographic characteristics at time of landing. METHODS We included all individuals (n = 1 080 908) who became permanent residents of Canada between Jan. 1, 1985, and Dec. 31, 2012, and were resident in BC at any time between 1985 and 2013. Multiple administrative databases were linked to the provincial TB registry. We used recursive partitioning models to identify populations with high TB yield. RESULTS Active TB was diagnosed in 2814 individuals (incidence rate 24.2/100 000 person-years). Demographic factors (live-in caregiver, family, refugee immigration classes; higher TB incidence in country of birth; and older age) were strong predictors of TB incidence in BC, with elevated rates continuing many years after entry into the cohort. Recursive partitioning identified refugees 18-64 years of age from countries with a TB incidence greater than 224/100 000 population as a high-yield group, with 1% developing TB within the first 10 years. INTERPRETATION These findings support recommendations in Canadian guidelines to target postlanding screening for and treatment of LTBI in adult refugees from high-incidence countries. Because high-yield populations can be identified at entry via demographic data, screening at this point may be practical and high-impact, particularly if the LTBI care cascade can be optimized.
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Affiliation(s)
- Lisa A Ronald
- Division of Respiratory Medicine, Faculty of Medicine (Ronald, Cook, Johnston), University of British Columbia; BC Centre for Disease Control (Ronald, Balshaw, Romanowski, Roth, Cook, Johnston); Faculty of Pharmaceutical Sciences (Campbell, Marra), University of British Columbia, Vancouver, BC
| | - Jonathon R Campbell
- Division of Respiratory Medicine, Faculty of Medicine (Ronald, Cook, Johnston), University of British Columbia; BC Centre for Disease Control (Ronald, Balshaw, Romanowski, Roth, Cook, Johnston); Faculty of Pharmaceutical Sciences (Campbell, Marra), University of British Columbia, Vancouver, BC
| | - Robert F Balshaw
- Division of Respiratory Medicine, Faculty of Medicine (Ronald, Cook, Johnston), University of British Columbia; BC Centre for Disease Control (Ronald, Balshaw, Romanowski, Roth, Cook, Johnston); Faculty of Pharmaceutical Sciences (Campbell, Marra), University of British Columbia, Vancouver, BC
| | - Kamila Romanowski
- Division of Respiratory Medicine, Faculty of Medicine (Ronald, Cook, Johnston), University of British Columbia; BC Centre for Disease Control (Ronald, Balshaw, Romanowski, Roth, Cook, Johnston); Faculty of Pharmaceutical Sciences (Campbell, Marra), University of British Columbia, Vancouver, BC
| | - David Z Roth
- Division of Respiratory Medicine, Faculty of Medicine (Ronald, Cook, Johnston), University of British Columbia; BC Centre for Disease Control (Ronald, Balshaw, Romanowski, Roth, Cook, Johnston); Faculty of Pharmaceutical Sciences (Campbell, Marra), University of British Columbia, Vancouver, BC
| | - Fawziah Marra
- Division of Respiratory Medicine, Faculty of Medicine (Ronald, Cook, Johnston), University of British Columbia; BC Centre for Disease Control (Ronald, Balshaw, Romanowski, Roth, Cook, Johnston); Faculty of Pharmaceutical Sciences (Campbell, Marra), University of British Columbia, Vancouver, BC
| | - Victoria J Cook
- Division of Respiratory Medicine, Faculty of Medicine (Ronald, Cook, Johnston), University of British Columbia; BC Centre for Disease Control (Ronald, Balshaw, Romanowski, Roth, Cook, Johnston); Faculty of Pharmaceutical Sciences (Campbell, Marra), University of British Columbia, Vancouver, BC
| | - James C Johnston
- Division of Respiratory Medicine, Faculty of Medicine (Ronald, Cook, Johnston), University of British Columbia; BC Centre for Disease Control (Ronald, Balshaw, Romanowski, Roth, Cook, Johnston); Faculty of Pharmaceutical Sciences (Campbell, Marra), University of British Columbia, Vancouver, BC
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Nordstoga I, Drage M, Steen TW, Winje BA. Wanting to or having to - a qualitative study of experiences and attitudes towards migrant screening for tuberculosis in Norway. BMC Public Health 2019; 19:796. [PMID: 31226971 PMCID: PMC6588894 DOI: 10.1186/s12889-019-7128-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 06/09/2019] [Indexed: 11/26/2022] Open
Abstract
Background This study assesses how tuberculosis (TB) screening is perceived by immigrants in Norway. Screening is mandatory for people arriving from high incidence countries. To attend screening, immigrants have to contact the health system after receiving an invitation by letter. The proportion of non-attenders is not known, and there are no sanctions for not attending. Generally, only persons who test positive receive test results. The study explores users’ experiences, attitudes and motivations for attending or not attending TB screening, and perceived barriers and enablers. Methods We conducted six focus group discussions and three individual interviews with 34 people from 16 countries in Africa, Asia and Europe. Interviews were recorded and transcribed, and data was coded following a general inductive approach: All transcribed text data was closely read through, salient themes were identified and categories were created and labelled. The data was read through several times and the category system was subsequently revised. Results Most appreciated the opportunity to be tested for a severe disease and were generally positive towards the healthcare system. At the same time, many were uncomfortable with screening, particularly due to the fear and stigma attached to TB. All experienced practical problems related to language, information, and accessing facilities. Having to ask others for help made them feel dependent and vulnerable. Positive and negative attitudes simultaneously created ambivalence. Many wanted “structuring measures” like sanctions to help attendance. Many said that not receiving results left them feeling anxious. Conclusions In order to adapt the system and improve trust and patient uptake, all aspects of the screening should be taken into account. Ambivalence towards screening probably has a negative impact on screening uptake and should be sought reduced. A combination of ambivalence and a wish for “structuring measures” leads the authors to conclude that mandatory screening is a reasonable measure. However, since mandatory screening negatively impacts patient autonomy, and because of fear, stigma and practical problems, the health system should empower users by improving communication and access to services. In addition, it is recommended that negative test results are also communicated to the users. Electronic supplementary material The online version of this article (10.1186/s12889-019-7128-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Mona Drage
- LHL International Tuberculosis Foundation, Oslo, Norway
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Vaccine-preventable diseases and immunisation coverage among migrants and non-migrants worldwide: A scoping review of published literature, 2006 to 2016. Vaccine 2019; 37:2661-2669. [DOI: 10.1016/j.vaccine.2019.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 03/30/2019] [Accepted: 04/01/2019] [Indexed: 02/07/2023]
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Fang XH, Shen HH, Hu WQ, Xu QQ, Jun L, Zhang ZP, Kan XH, Ma DC, Wu GC. Prevalence of and Factors Influencing Anti-Tuberculosis Treatment Non-Adherence Among Patients with Pulmonary Tuberculosis: A Cross-Sectional Study in Anhui Province, Eastern China. Med Sci Monit 2019; 25:1928-1935. [PMID: 30869079 PMCID: PMC6429981 DOI: 10.12659/msm.913510] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To assess the non-adherence rate among pulmonary tuberculosis (TB) patients in Anhui Province, eastern China and to explore the influential factors, so as to identify targets for intervention. MATERIAL AND METHODS A total of 339 TB patients were recruited from TB dispensaries in 8 counties of Anhui Province, eastern China using a stratified sampling method. All study subjects were surveyed using a structured questionnaire. Differences between groups involving categorical data were analyzed using the chi-square test. RESULTS Overall, of the 339 patients, 33.63% missed medication. Divorced and widowed patients were more likely to miss medication compared with those who were married or unmarried (P<0.01). Regarding the knowledge related to topics such as transmission route, preventive measures, and suspicious symptoms, the awareness rate in the group with good medication compliance was higher than in the group with poor compliance (P<0.05). We found that compliance was not significantly associated with seeking medical treatment in professional institutions, the national free TB treatment policy, or discrimination (P>0.05). The rate of non-compliance under supervision (26.10%) was lower than that without supervision (64.18%) (P<0.001). CONCLUSIONS The anti-TB treatment non-adherence rate in TB patients is relatively high in Anhui Province, eastern China, and is associated with marital status, annual income, TB knowledge, and medical staff visits.
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Affiliation(s)
- Xue-Hui Fang
- Anhui Provincial TB (Tuberculosis) Institute, Hefei, Anhui, China (mainland)
| | - Hui-Hui Shen
- Department of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Wan-Qian Hu
- Department of Clinical Medicine, College of Medicine, Yangzhou University, Yangzhou, Jiangsu, China (mainland)
| | - Qi-Qi Xu
- Department of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Lei Jun
- Anhui Provincial TB (Tuberculosis) Institute, Hefei, Anhui, China (mainland)
| | - Zhi-Ping Zhang
- Anqing Center for Disease Control and Prevention, Anqing, Anhui, China (mainland)
| | - Xiao-Hong Kan
- Anhui Provincial TB (Tuberculosis) Institute, Hefei, Anhui, China (mainland)
| | - Dong-Chun Ma
- Anhui Provincial TB (Tuberculosis) Institute, Hefei, Anhui, China (mainland)
| | - Guo-Cui Wu
- School of Nursing, Anhui Medical University, Hefei, Anhui, China (mainland)
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A scoping review of health-related stigma outcomes for high-burden diseases in low- and middle-income countries. BMC Med 2019; 17:17. [PMID: 30764819 PMCID: PMC6376728 DOI: 10.1186/s12916-019-1250-8] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 01/02/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Stigma is associated with health conditions that drive disease burden in low- and middle-income countries (LMICs), including HIV, tuberculosis, mental health problems, epilepsy, and substance use disorders. However, the literature discussing the relationship between stigma and health outcomes is largely fragmented within disease-specific siloes, thus limiting the identification of common moderators or mechanisms through which stigma potentiates adverse health outcomes as well as the development of broadly relevant stigma mitigation interventions. METHODS We conducted a scoping review to provide a critical overview of the breadth of research on stigma for each of the five aforementioned conditions in LMICs, including their methodological strengths and limitations. RESULTS Across the range of diseases and disorders studied, stigma is associated with poor health outcomes, including help- and treatment-seeking behaviors. Common methodological limitations include a lack of prospective studies, non-representative samples resulting in limited generalizability, and a dearth of data on mediators and moderators of the relationship between stigma and health outcomes. CONCLUSIONS Implementing effective stigma mitigation interventions at scale necessitates transdisciplinary longitudinal studies that examine how stigma potentiates the risk for adverse outcomes for high-burden health conditions in community-based samples in LMICs.
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Rosales-Klintz S, Bruchfeld J, Haas W, Heldal E, Houben RM, van Kessel F, Mandelbaum M, Matteelli A, Migliori GB, Oordt-Speets A, Solovic I, Vašáková M, Verver S, de Vlas SJ, Vonk Noordegraaf-Schouten MJ, de Vries G, Zenner D, van der Werf MJ. Guidance for programmatic management of latent tuberculosis infection in the European Union/European Economic Area. Eur Respir J 2019; 53:53/1/1802077. [DOI: 10.1183/13993003.02077-2018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 11/09/2018] [Indexed: 11/05/2022]
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