Multidrug-resistant tuberculosis treatment adherence in migrants: a systematic review and meta-analysis

Abstract

BackgroundMultidrug-resistant tuberculosis (MDR-TB) is a growing concern in meeting global targets for TB control. In high-income low-TB-incidence countries, a disproportionate number of MDR-TB cases occur in migrant (foreign-born) populations, with concerns about low adherence rates in these patients compared to the host non-migrant population. Tackling MDR-TB in this context may, therefore, require unique approaches. We conducted a systematic review and meta-analysis to identify and synthesise data on MDR-TB treatment adherence in migrant patients to inform evidence-based strategies to improve care pathways and health outcomes in this group.MethodsThis systematic review and meta-analysis was conducted in line with PRISMA guidelines (PROSPERO 42017070756). The databases Embase, MEDLINE, Global Health and PubMed were searched to 24 May 2017 for primary research reporting MDR-TB treatment adherence and outcomes in migrant populations, with no restrictions on dates or language. A meta-analysis was conducted using random-effects models.ResultsFrom 413 papers identified in the database search, 15 studies reporting on MDR-TB treatment outcomes for 258 migrants and 174 non-migrants were included in the systematic review and meta-analysis. The estimated rate of adherence to MDR-TB treatment across migrant patients was 71% [95% confidence interval (CI) = 58–84%], with non-adherence reported among 20% (95% CI = 4–37%) of migrant patients. A key finding was that there were no differences in estimated rates of adherence [risk ratio (RR) = 1.05; 95% CI = 0.82–1.34] or non-adherence (RR = 0.97; 95% CI = 0.79–1.36) between migrants and non-migrants.ConclusionsMDR-TB treatment adherence rates among migrants in high-income low-TB-incidence countries are approaching global targets for treatment success (75%), and are comparable to rates in non-migrants. The findings highlight that only just over 70% of migrant and non-migrant patients adhere to MDR-TB treatment. The results point to the importance of increasing adherence in all patient groups, including migrants, with an emphasis on tailoring care based on social risk factors for poor adherence. We believe that MDR-TB treatment targets are not ambitious enough.

<p>Factors Influencing Medication Nonadherence to Pulmonary Tuberculosis Treatment in Tibet, China: A Qualitative Study from the Patient Perspective</p>

“…17,18 Social risk factors, such as social deprivation, vulnerable housing, mental health concerns or other comorbidities, also contributed to medication nonadherence. 19 Taken together, the above studies indicate that different factors are related to medication nonadherence in different regions. Hence, identifying specific factors that contribute to medication nonadherence to PTB treatment in different settings is important to design appropriate interventions to improve adherence.…”

“…17 , 18 Social risk factors, such as social deprivation, vulnerable housing, mental health concerns or other comorbidities, also contributed to medication nonadherence. 19 …”

Defining a migrant-inclusive tuberculosis research agenda to end TB

“…Migrants with TB often have lower treatment success rates than native-born individuals. 48–51 Understanding the underlying reasons for this is critical and context-specific. Several studies have shown that, even at the subnational level, identifying and targeting factors associated with default or loss to follow-up can improve health systems responses to TB treatment provision in migrant populations.…”

Improving access to multi-drug resistant tuberculosis diagnostic and health services for refugees and migrants

“…Cross-transmission between migrants and Brazilians was confirmed, yet the contribution by migrants was not substantial. Nellums et al [ 18 ] conducted a systematic review and metanalyses of 15 selected studies reporting MDR-TB treatment outcomes for 258 migrants and 174 non-migrants in European countries. The estimated rate of adherence to MDR-TB treatment across all patients was 71% .…”