Impact of Port of Entry Referrals on Initiation of Follow-Up Evaluations for Immigrants with Suspected Tuberculosis: Illinois

Abstract

US-bound immigrants with suspected non-infectious TB are encouraged to be medically re-evaluated after arrival in the United States. We evaluated the Centers for Disease Control and Prevention's immigrant referral process, designed to facilitate timely post-arrival evaluations. Over 1,200 immigrants with suspected TB arriving during October 1, 2008-September 30, 2010 were identified. In 2011, differences in days to evaluation initiation were assessed by referral type using survival analysis and Cox proportional hazard models. Among those receiving any referral, median time to post-arrival evaluation was significantly lower compared with immigrants receiving no referral (16 vs. 69 days, respectively; p < 0.0001). After adjusting for the covariates, immigrants receiving any referral initiated follow-up at 4 times the rate (adjusted hazard ratio = 4.0; p < 0.0001) of those receiving no referral. Implementing a referral system at US ports of entry will improve timeliness and increase the proportion of immigrants initiating domestic evaluation.

Effectiveness of interventions for diagnosis and treatment of tuberculosis in hard-to-reach populations in countries of low and medium tuberculosis incidence: a systematic review

“…Characteristics for all nineteen included studies are described in Table 1, evidence tables are in Supplementary Material IV. Twelve of the included studies focussed on migrants, [29][30][31][32][33][34][35][36]38,41,43,45 of which one focussed on children. 41 Three studies focussed on mixed hard-to-reach populations; 39, 42,46 two on drug users; 40,44 one on people living with HIV 47 and one on homeless people.…”

“…Eight studies were conducted in the EU, two in the United Kingdom (UK), 39,42 one in Estonia, 44 one in France, 37 one in Germany, 46 one in Italy, 47 one in Norway 32 and one in Portugal. 40 The remaining eleven studies were conducted outside the EU, eight in the United States (US), 29,31,[33][34][35][36]41,43 two in Israel 30,38 and one in Switzerland. 45 The interventions to improve identification of TB applied active case finding by using (mobile) CXR, 30,[37][38][39]42 symptom-based questionnaire, 45 TST or IGRA 31,36,41 ; adding sputum smear 34,39 or sputum culture 29,33,43 to a screening algorithm; and active referral to a TB clinic.…”

“…45 The interventions to improve identification of TB applied active case finding by using (mobile) CXR, 30,[37][38][39]42 symptom-based questionnaire, 45 TST or IGRA 31,36,41 ; adding sputum smear 34,39 or sputum culture 29,33,43 to a screening algorithm; and active referral to a TB clinic. 32,35,40,44 The interventions to manage TB were enhanced case management, i.e. a package of supportive care tailored to patients' needs, 40,42,46 and concomitant TB and HIV treatment.…”

“…Bell and colleagues examined the effect of different support activities for referral to post-arrival follow-up appointments for migrants with suspected non-infectious TB entering the US. 35 These migrants were informed to attend a follow-up appointment in the US within 30 days of arrival.…”

“…This systematic review identified 19 new studies [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] published between 2010 and 2015, on top of the 26 studies, published between 1990 and 2010, identified for the NICE reviews. 24,25…”