Latent tuberculosis screening and treatment among asylum seekers: a mixed methods study
InekeÂ Spruijt,Â DawitÂ Tesfay Haile,Â JeanineÂ Suurmond,Â SusanÂ van den Hof,Â MargaÂ Koenders,Â PeterÂ Kouw,Â NataschaÂ van Noort,Â SophieÂ Toumanian,Â FrankÂ Cobelens,Â SimoneÂ Goosen,Â ConnieÂ Erkens
European Respiratory JournalÂ 2019;Â DOI:Â 10.1183/13993003.00861-2019
IntroductionÂ Evidence on conditions for implementation of latent tuberculosis (TB) infection screening and treatment among asylum seekers is needed to inform TB control policies. We used mixed-methods to evaluate the implementation of a latent TB infection (LTBI) screening and treatment program among asylum seekers in the Netherlands.
MethodsÂ We offered voluntary LTBI screening to asylum seekers aged â‰¥12â€…years living in asylum seeker centres from countries with a TB incidence >200/100â€Š000 population. We calculated LTBI screening and treatment cascade coverages and assessed associated factors with Poisson regression using robust variance estimators. We interviewed TB care staff (7 group interviews) and Eritrean clients (21 group and 21 individual interviews) to identify program enhancers and barriers.
ResultsÂ We screened 719 (63% of 1136) clients for LTBI. LTBI was diagnosed among 178 (25%) clients: 149 (84%) initiated LTBI treatment, of whom 129 (87%) completed treatment. In-person TB and LTBI education, the use of professional interpreters, and collaboration with partner organisations were enhancers for LTBI screening uptake. Demand-driven LTBI treatment support by TB nurses enhanced treatment completion. Factors complicating LTBI screening and treatment were having to travel to public health service, language barriers and moving from asylum seeker centres to the community during treatment.
ConclusionÂ LTBI screening and treatment of asylum seekers is feasible and effective when high quality of care is provided including culture sensitive TB education throughout the care cascade. Additionally, collaboration with partner organisations, such as agencies responsible for reception and support of asylum seekers, should be in place.
This manuscript has recently been accepted for publication in theÂ European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of theÂ ERJÂ online. Please open or download the PDF to view this article.
Conflict of interest: Dr. Spruijt reports grants and other from KNCV Tuberculosis Foundation, during the conduct of the study.
Conflict of interest: Dr. Tesfay Haile has nothing to disclose.
Conflict of interest: Dr. Suurmond has nothing to disclose.
Conflict of interest: Dr. van den Hof has nothing to disclose.
Conflict of interest: M. Koenders has nothing to disclose.
Conflict of interest: Dr. Kouw has nothing to disclose.
Conflict of interest: Dr. van Noort has nothing to disclose.
Conflict of interest: Dr. Toumanian has nothing to disclose.
Conflict of interest: Dr. Cobelens has nothing to disclose.
Conflict of interest: Dr. Goosen has nothing to disclose.
Conflict of interest: Dr. Erkens has nothing to disclose.
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