A Systematic Review on TST and IGRA Tests Used for Diagnosis of LTBI in Immigrants

Campbell, Jonathon R.; Krot, Jane; Elwood, Kevin; Cook, Victoria; Marra, Fawziah

doi:10.1007/s40291-014-0125-0

Cited by 55 publications

(40 citation statements)

References 70 publications

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“…Main recommendations regarding particular issues [22] and failing to cover the targeted populations [4,22,23], failing to provide information on how to improve screening and treatment coverage and completion [23], and being insufficiently based on evidence and evidence synthesis [24] (see Table 3 at the end of the manuscript). Previous studies of refugee/asylum seeker populations have mainly been concerned with screening and treatment strategies, as well as the cost-effectiveness of tuberculosis prevention in immigrants from high to lower-incidence regions [25][26][27]. Studies of respiratory infections other than tuberculosis shows that more resources for prevention and control of acute respiratory infections (ARI) are needed [8] and that there should be a particular focus on vaccine-preventable infections [9] (see Table 3).…”

Section: Guidelinementioning

confidence: 99%

Reducing burden from respiratory infections in refugees and immigrants: a systematic review of interventions in OECD, EU, EEA and EU-applicant countries

Lambert

Stete

Balmford

et al. 2020

Preprint

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Background Respiratory diseases are a major reason for recently arrived migrants seeking health care in countries of arrival. The burden of respiratory diseases in refugees is exacerbated by poor living conditions and crowding. The lack of synthesised evidence and guideline-relevant information to reduce morbidity and mortality from respiratory infections endangers this population. Methods A systematic review of all controlled and observational studies assessing interventions targeting the treatment, diagnosis and management of respiratory infections in refugees and immigrants in OECD, EU, EEA and EU-applicant countries published between 2000 and 2019 in MEDLINE, CINAHL, PSYNDEX and Web of Science. Results Nine of 5779 identified unique records met our eligibility criteria. Seven studies reported an increase in vaccine coverage from 2% – 52% after educational multilingual interventions for respiratory-related childhood diseases (4 studies) and for influenza (5 studies). There was limited evidence in one study that hand sanitiser reduced rates of upper respiratory infections and when provided together with face masks also the rates of influenza-like-illness in a hard to reach migrant neighbourhood. In outbreak situations of vaccine-preventable diseases, secondary cases and outbreak hazards were reduced by general vaccination strategies early after arrival but not by serological testing after exposure (1 study). We identified evidence gaps regarding interventions assessing housing standards, reducing burden of bacterial pneumonia and implementation of operational standards in refugee care and reception centres. Conclusions Multilingual health literacy interventions should be considered to increase uptake of vaccinations in refugees and immigrants. Well designed controlled studies on housing and operational standards in refugee population early after arrival as well as adequate ways to gain informed consent for early vaccinations in mass housing is required to inform guidelines.

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Section: Guidelinementioning

confidence: 99%

Reducing burden from respiratory infections in refugees and immigrants: a systematic review of interventions in OECD, EU, EEA and EU-applicant countries

Lambert

Stete

Balmford

et al. 2020

Preprint

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“…Insufficient review level evidence for direct or indirect effects of interventions Screening Whilst migrants from high TB incidence countries often have a higher prevalence of active and latent TB than the general population in low TB incidence countries, there was insufficient evidence from systematic reviews to either support or discount the effectiveness of different screening approaches to prevent TB cases, reducing TB incidence, reducing mortality or preventing transmission. Eight supplementary reviews of migrant screening (two reviewing pre-entry screening/follow-up [32,34], one point-of-entry screening [42], four post-entry screening [33,[36][37][38] and one screening at all three points [45]) favoured pre-or post-entry screening of migrants from high TB-incidence countries (based mainly on case yield and risk of TB developing post-entry) compared with no screening, but none compared the effectiveness of different approaches or provided conclusive evidence of cost-effectiveness. All eight reviews stressed the need for comparative studies and improved longitudinal data collection.…”

Section: Hiv/tbmentioning

confidence: 99%

Effectiveness of interventions for reducing TB incidence in countries with low TB incidence: a systematic review of reviews

et al. 2019

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AimsWhat is the evidence base for the effectiveness of interventions to reduce tuberculosis (TB) incidence in countries which have low TB incidence?MethodsWe conducted a systematic review of interventions for TB control and prevention relevant to low TB incidence settings (<10 cases per 100 000 population). Our analysis was stratified according to “direct” or “indirect” effects on TB incidence. Review quality was assessed using AMSTAR2 criteria. We summarised the strength of review level evidence for interventions as “sufficient”, “tentative”, “insufficient” or “no” using a framework based on the consistency of evidence within and between reviews.ResultsWe found sufficient review level evidence for direct effects on TB incidence/case prevention of vaccination and treatment of latent TB infection. We also found sufficient evidence of beneficial indirect effects attributable to drug susceptibility testing and adverse indirect effects (measured as sub-optimal treatment outcomes) in relation to use of standardised first-line drug regimens for isoniazid-resistant TB and intermittent dosing regimens. We found insufficient review level evidence for direct or indirect effects of interventions in other areas, including screening, adherence, multidrug-resistant TB, and healthcare-associated infection.DiscussionOur review has shown a need for stronger evidence to support expert opinion and country experience when formulating TB control policy.

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“…The advantages of IGRAs include the practical benefit of a single blood test with no need for patient recall to read the result. These assays are more costly than TST, although the savings may be offset by, for instance, healthcare worker time and possible better specificity leading to fewer individuals being treated for LTBI .…”

Section: Diagnosis and Treatment Of Ltbi In Hiv‐positive Adultsmentioning

confidence: 99%

British HIV Association guidelines for the management of tuberculosis in adults living with HIV 2019

et al. 2019

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A Systematic Review on TST and IGRA Tests Used for Diagnosis of LTBI in Immigrants

Cited by 55 publications

References 70 publications

Reducing burden from respiratory infections in refugees and immigrants: a systematic review of interventions in OECD, EU, EEA and EU-applicant countries

Reducing burden from respiratory infections in refugees and immigrants: a systematic review of interventions in OECD, EU, EEA and EU-applicant countries

Effectiveness of interventions for reducing TB incidence in countries with low TB incidence: a systematic review of reviews

British HIV Association guidelines for the management of tuberculosis in adults living with HIV 2019

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