Completion of screening for latent tuberculosis infection among immigrants

Abstract

The objective of our study was to evaluate the sociodemographic factors associated with completion of screening for latent tuberculosis infection (LTBI) among undocumented immigrants in Brescia, Italy. Screening for LTBI was offered to 649 immigrants; 213 (33%) immigrants completed the first step of screening; only 44% (55/124) of individuals with a positive tuberculin skin test result started treatment for LTBI. The univariate analysis showed that being unmarried, of Senegalese nationality and being interviewed by a health-care worker with the same native language as the immigrant were significantly associated with completion of screening for LTBI. In the multiple logistic regression, being interviewed in the native language of the health-care worker (OR 2.5, 95% CI 1.3-4.8, P = 0.004) and being of Senegalese origin (OR 2.3, 95% CI 1.4-3.6, P = 0.0005) were independently associated with adherence to LTBI screening. Our results suggest that knowledge of the sociodemographic characteristics of immigrants, and the participation of health-care workers of the same cultural origin as the immigrant during the visits, can be an important tool to improve completion of screening for LTBI.

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

“…Across the 51 studies, 34 studies looked at TST alone and 9 studies looked at IGRAs alone [57][58][59][60][61][62][63][64][65]; 8 studies compared TST and IGRAs [66][67][68][69][70][71][72][73]. Just 8 studies excluded those with active TB from their study [23,32,34,50,66,68,69,71]. Only 16 studies reported on BCG vaccination with 9 using BCG scar as evidence of vaccination [28,32,33,53,55,58,60,71,72], 5 using BCG self-reporting as evidence [23,29,35,66,69], and 2 using BCG vaccination schedule in country of origin as a proxy for BCG vaccination [48,73], although BCG vaccination rates varied considerably across studies (0-100 %).…”

“…Of the 9,349 immigrants with a positive TST, 5,041 (53.9 %) were recommended LTBI treatment compared to 511 (43.1 %) of the 1,186 immigrants with a positive IGRA being recommended for LTBI treatment (p \ 0.0001). In the TST group, two studies excluded those with active TB [23,34], however the prevalence of positive tests did not differ significantly between studies that did and did not exclude active TB (p [ 0.05). We found only 3 longitudinal follow-up studies for development of active TB.…”

Evidence-based clinical guidelines for immigrants and refugees

“…Patient-related barriers include the stigma of tuberculosis and its association with HIV, linguistic barriers and difficulties getting to appointments because of inconvenient clinic locations or limited clinic hours. [233][234][235][236] Provider-related barriers to offering screening to migrants are related to inadequate knowledge of which migrants should be screened and how they should be followed. 237 Low adherence to treatment for latent tuberculosis infection is associated with barriers similar to those for screening for latent tuberculosis.…”

Tuberculosis: evidence review for newly arriving immigrants and refugees

“…Patient barriers include the stigma of tuberculosis and its association with HIV, linguistic barriers and difficulties coming to appointments because of inconvenient clinic locations or limited clinic hours. 121,[134][135][136] Provider barriers to offering screening to migrants are related to inadequate knowledge of which migrants should be screened or how they should be followed up. [137][138][139] Low adherence to treatment for latent tuberculosis infection is associated with barriers similar to those with screening latent tuberculosis.…”