Screening for Tuberculosis in Migrants: A Survey by the Global Tuberculosis Network

Adherence to Short-Duration Treatment (3HP) for Latent Tuberculosis among International Migrants in Manaus, Amazonas: Evaluation of the Efficacy of Different Treatment Modalities

Migration, a multifaceted phenomenon, has a significant impact on health. Migrants perform similar movement patterns within their country of origin, in transit, and in the country of destination, thus making it difficult to monitor TB treatment throughout the journey. The objective was to compare the effectiveness of different treatment modalities in adherence to the short-term regimen for LTBI (3HP) among international migrants and refugees. This is a quasi-experimental study conducted in Manaus-AM. The study population was made up of international migrants. The certification and monitoring of medication intake employed three strategies: self-administration (SA), directly observed conventional therapy (DOT), and Video Telemonitoring System for Tuberculosis Treatment (VDOT). The VDOT group and SA group exhibited the lowest rate of treatment dropout or interruption at 16.1%, followed by the DOT group at 23.1%. The results suggest that the most effective strategy for ensuring adherence among migrants and refugees was VDOT (OR_adj 0.26; CI 0.7-0.94), suggesting that migrants may be more likely to adhere to and complete their treatment. The results show that relying on different treatment strategies, adapted to the individuals' needs and risk factors, is a viable and effective way of providing person-centered TB care.

Active Case Finding for Tuberculosis in Migrants: a Systematic Review

Background

Active case finding (ACF) is an alternative strategy to accelerate the identification of TB cases among the migrant population.

Objective

This study aimed to synthesize the evidence for the effectiveness of ACF TB in migrants.

Methods

This study uses the PRISMA model as a method of searching for journal articles in the databases of Google Scholar, ProQuest, EBSCO, ScienceDirect, Elsevier, and PubMed, as well as other sources such as textbooks and reports from 2017 to 2021 with the keywords "tuberculosis" AND "active case finding" AND "migrant". The search revealed 371 articles, of which 26 met the criteria for further discussion.

Results

Most studies show that the TB incidence among migrants is higher than in the local population. Factors leading to increased cases include lack of knowledge about the symptoms, high mobilization, social isolation, economic problems, and medication adherence that impact an advanced stage. Furthermore, it is also influenced by the low quality of health services, including accessibility, health facilities, health workers, and information. Therefore, Active Case Finding (ACF) is more effective in identifying cases of TB in the risk groups. This was conducted on migrants with increased notifications followed up with treatment.

Conclusion

ACF is effective approach in screening and diagnosing TB in the migrant group.

Migration and medical screening for tuberculosis

Vulnerable populations, such as migrants and refugees, have an increased risk of tuberculosis disease, especially in the first years after arrival in the host country. The presence of migrants and refugees in Brazil exponentially grew over the period between 2011 and 2020, and approximately 1.3 million migrants from the Global South were estimated to be residing in Brazil, most of whom from Venezuela and Haiti. Tuberculosis control programs for migrants can be divided into pre- and post-migration screening strategies. Pre-migration screening aims to identify cases of tuberculosis infection (TBI) and can be carried out in the country of origin (pre-entry) or in the destination country (at entry). Pre-migration screening can also detect migrants at an increased risk of developing tuberculosis in the future. High-risk migrants are then followed up in post-migration screening. In Brazil, migrants are considered a priority group for the active search for tuberculosis cases. However, there is no recommendation or plan regarding screening for TBI in migrants and refugees. Ensuring prevention, diagnosis, and treatment for TBI and tuberculosis disease in migrant populations is an important aspect of tuberculosis control and elimination. In this review article, we address epidemiological aspects and access to health care for migrants in Brazil. In addition, the migration medical screening for tuberculosis was reviewed.

Screening for Tuberculosis Infection among Migrants: A Cost-Effectiveness Analysis in the Italian Context

BACKGROUND

Screening of tuberculosis infection (TBI) among migrants from high-incidence countries is a cornerstone of tuberculosis control in low-incidence countries. However, the optimal screening strategy has not been defined yet.

METHODS

A quasi-experimental study involving migrants residing in the province of Brescia was carried out that aimed at assessing the completion rate, time to completion, preventive treatment initiation rate, and cost-effectiveness of two strategies for TBI screening. They underwent TBI screening with the IGRA-only strategy (arm 1) or with the sequential strategy (tuberculin skin test, TST, followed by IGRA in case of a positive result-arm 2). The two strategies were compared in terms of screening completion, time to complete the screening process, therapy initiation, and cost-effectiveness.

RESULTS

Between May 2019 and May 2022, 657 migrants were evaluated, and 599 subjects were included in the study, with 358 assigned to arm 1 and 237 to arm 2. Screening strategy was the only factor associated with screening completion in a multivariable analysis, with the subjects assigned to the IGRA-only strategy more likely to complete the screening cascade (n = 328, 91.6% vs. n = 202, 85.2%, IRR 1.08, 95% CI (1.01-1.14), p = 0.019). The time to complete the screening process was significantly longer for patients assigned to the sequential strategy arm (74 days vs. 46 days, p = 0.002). Therapy initiation did not significantly differ between the two arms, and cost-effectiveness was higher for the sequential strategy.

CONCLUSION

Sequential strategy implementation for TBI screening among migrants may be justified by its higher cost-effectiveness in spite of the lower completion of the screening cascade.

Observatorios sociales nacionales y regional de tuberculosis en ocho países de Latinoamérica y el Caribe

Poner fin a la tuberculosis (TB) requiere de un enfoque y participación multisectorial, incluyendo a la sociedad civil organizada. Entonces con el apoyo de un proyecto regional financiado por el Fondo Mundial (OBSERVA TB), desde el año 2019 se conformaron observatorios sociales de tuberculosis en 8 países de Latinoamérica y el Caribe (LAC) (Bolivia, Colombia, El Salvador, Guatemala, Haití, México, Perú y República Dominicana) y un Observatorio Social Regional de TB, como expresión de la implementación del enfoque ENGAGE-TB impulsado por la Organización Mundial de la Salud. Este artículo presenta el modelo de implementación, los avances y los desafíos de los observatorios sociales de tuberculosis. A diciembre de 2021, se incluyeron 135 organizaciones de la sociedad civil de LAC en los 8 observatorios implementados, espacios que sirven como plataformas para la vigilancia social, la incidencia política y el monitoreo social de las respuestas nacionales contra la TB, además de contribuir a los indicadores del ENGAGE-TB relacionados a la detección de casos TB y a los apoyos durante el tratamiento. Por ello, recomendamos la consolidación y expansión de los observatorios existentes, así como la participación de otros países de la región LAC.