Latent tuberculosis screening and treatment among asylum seekers: a mixed-methods study

IntroductionEvidence on conditions for implementation of latent tuberculosis infection (LTBI) screening and treatment among asylum seekers is needed to inform tuberculosis (TB) control policies. We used mixed-methods to evaluate the implementation of an LTBI screening and treatment programme among asylum seekers in the Netherlands.MethodsWe offered voluntary LTBI screening to asylum seekers aged ≥12 years living in asylum seeker centres from countries with a TB incidence >200 per 10 000 population. We calculated LTBI screening and treatment cascade coverage, and assessed associated factors with Poisson regression using robust variance estimators. We interviewed TB care staff (seven group interviews) and Eritrean clients (21 group and 21 individual interviews) to identify programme enhancers and barriers.ResultsWe 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 services, language barriers and moving from asylum seeker centres to the community during treatment.ConclusionLTBI 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.

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Knowledge, attitudes, beliefs, and stigma related to latent tuberculosis infection: a qualitative study among Eritreans in the Netherlands

BMC Public Health ◽

10.1186/s12889-020-09697-z ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Ineke Spruijt ◽

Dawit Tesfay Haile ◽

Susan van den Hof ◽

Kathy Fiekert ◽

Niesje Jansen ◽

...

Keyword(s):

The Netherlands ◽

Asylum Seekers ◽

Cultural Beliefs ◽

Latent Tuberculosis ◽

Treatment Programs ◽

Ltbi Treatment ◽

Treatment Cascade ◽

Ltbi Screening ◽

Latent Tb Infection ◽

Asylum Seekers And Refugees

Abstract Background Tailored and culturally appropriate latent tuberculosis (TB) infection screening and treatment programs, including interventions against TB stigma, are needed to reduce TB incidence in low TB incidence countries. However, we lack insights in stigma related to latent TB infection (LTBI) among target groups, such as asylum seekers and refugees. We therefore studied knowledge, attitudes, beliefs, and stigma associated with LTBI among Eritrean asylum seekers and refugees in the Netherlands. Methods We used convenience sampling to interview adult Eritrean asylum seekers and refugees: 26 semi-structured group interviews following TB and LTBI related health education and LTBI screening, and 31 semi-structured individual interviews with Eritreans during or after completion of LTBI treatment (November 2016–May 2018). We used a thematic analysis to identify, analyse and report patterns in the data. Results Despite TB/LTBI education, misconceptions embedded in cultural beliefs about TB transmission and prevention persisted. Fear of getting infected with TB was the cause of reported enacted (isolation and gossip) and anticipated (concealment of treatment and self-isolation) stigma by participants on LTBI treatment. Conclusion The inability to differentiate LTBI from TB disease and consequent fear of getting infected by persons with LTBI led to enacted and anticipated stigma comparable to stigma related to TB disease among Eritreans. Additional to continuous culturally sensitive education activities, TB prevention programs should implement evidence-based interventions reducing stigma at all phases in the LTBI screening and treatment cascade.

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Knowledge, attitudes, beliefs, and stigma related to latent tuberculosis infection: a qualitative study among Eritreans in the Netherlands

10.21203/rs.3.rs-15581/v3 ◽

2020 ◽

Author(s):

Ineke Spruijt ◽

Dawit Tesfay Haile ◽

Susan van den Hof ◽

Kathy Fiekert ◽

Niesje Jansen ◽

...

Keyword(s):

The Netherlands ◽

Asylum Seekers ◽

Cultural Beliefs ◽

Latent Tuberculosis ◽

Treatment Programs ◽

Ltbi Treatment ◽

Treatment Cascade ◽

Ltbi Screening ◽

Latent Tb Infection ◽

Asylum Seekers And Refugees

Abstract Background: Tailored and culturally appropriate latent tuberculosis (TB) infection screening and treatment programs, including interventions against TB stigma, are needed to reduce TB incidence in low TB incidence countries. However, we lack insights in stigma related to latent TB infection (LTBI) among target groups, such as asylum seekers and refugees. We therefore studied knowledge, attitudes, beliefs and stigma associated with LTBI among Eritrean asylum seekers and refugees in the Netherlands.Methods: We used convenience sampling to interview adult Eritrean asylum seekers and refugees: 26 semi-structured group interviews following TB and LTBI related health education and LTBI screening, and 31 semi-structured individual interviews with Eritreans during or after completion of LTBI treatment (November 2016-May 2018). We used a thematic analysis to identify, analyse and report patterns in the data.Results: Despite TB/LTBI education, misconceptions embedded in cultural beliefs about TB transmission and prevention persisted. Fear of getting infected with TB was the cause of reported enacted (isolation and gossip) and anticipated (concealment of treatment and self-isolation) stigma by participants on LTBI treatment. Conclusion: The inability to differentiate LTBI from TB disease and consequent fear of getting infected by persons with LTBI led to enacted and anticipated stigma comparable to stigma related to TB disease among Eritreans. Additional to continuous culturally sensitive education activities, TB prevention programs should implement evidence-based interventions reducing stigma at all phases in the LTBI screening and treatment cascade.

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Knowledge, attitudes, beliefs, and stigma related to latent tuberculosis infection: a qualitative study among Eritreans in the Netherlands

10.21203/rs.3.rs-15581/v2 ◽

2020 ◽

Author(s):

Ineke Spruijt ◽

Dawit Tesfay Haile ◽

Susan van den Hof ◽

Kathy Fiekert ◽

Niesje Jansen ◽

...

Keyword(s):

The Netherlands ◽

Asylum Seekers ◽

Cultural Beliefs ◽

Latent Tuberculosis ◽

Treatment Programs ◽

Ltbi Treatment ◽

Treatment Cascade ◽

Ltbi Screening ◽

Latent Tb Infection ◽

Asylum Seekers And Refugees

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Knowledge, attitudes, beliefs, and stigma related to latent tuberculosis infection: a qualitative study among Eritreans in the Netherlands

10.21203/rs.3.rs-15581/v4 ◽

2020 ◽

Author(s):

Ineke Spruijt ◽

Dawit Tesfay Haile ◽

Susan van den Hof ◽

Kathy Fiekert ◽

Niesje Jansen ◽

...

Keyword(s):

The Netherlands ◽

Asylum Seekers ◽

Cultural Beliefs ◽

Latent Tuberculosis ◽

Treatment Programs ◽

Ltbi Treatment ◽

Treatment Cascade ◽

Ltbi Screening ◽

Latent Tb Infection ◽

Asylum Seekers And Refugees

Abstract Background: Tailored and culturally appropriate latent tuberculosis (TB) infection screening and treatment programs, including interventions against TB stigma, are needed to reduce TB incidence in low TB incidence countries. However, we lack insights in stigma related to latent TB infection (LTBI) among target groups, such as asylum seekers and refugees. We therefore studied knowledge, attitudes, beliefs, and stigma associated with LTBI among Eritrean asylum seekers and refugees in the Netherlands.Methods: We used convenience sampling to interview adult Eritrean asylum seekers and refugees: 26 semi-structured group interviews following TB and LTBI related health education and LTBI screening, and 31 semi-structured individual interviews with Eritreans during or after completion of LTBI treatment (November 2016-May 2018). We used a thematic analysis to identify, analyse and report patterns in the data.Results: Despite TB/LTBI education, misconceptions embedded in cultural beliefs about TB transmission and prevention persisted. Fear of getting infected with TB was the cause of reported enacted (isolation and gossip) and anticipated (concealment of treatment and self-isolation) stigma by participants on LTBI treatment.Conclusion: The inability to differentiate LTBI from TB disease and consequent fear of getting infected by persons with LTBI led to enacted and anticipated stigma comparable to stigma related to TB disease among Eritreans. Additional to continuous culturally sensitive education activities, TB prevention programs should implement evidence-based interventions reducing stigma at all phases in the LTBI screening and treatment cascade.

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Implementation of latent tuberculosis screening in HIV care centres: evaluation in a low tuberculosis incidence setting

Epidemiology and Infection ◽

10.1017/s0950268815001594 ◽

2015 ◽

Vol 144 (4) ◽

pp. 703-711 ◽

Cited By ~ 4

Author(s):

C. WYNDHAM-THOMAS ◽

K. SCHEPERS ◽

V. DIRIX ◽

F. MASCART ◽

J.-P. VAN VOOREN ◽

...

Keyword(s):

Latent Tuberculosis Infection ◽

Latent Tuberculosis ◽

Screening Tools ◽

Hiv Care ◽

Screening Methods ◽

Tuberculosis Screening ◽

Ltbi Treatment ◽

Ltbi Screening ◽

Multiple Choice Questionnaire ◽

Targeted Approach

SUMMARYThe screening and treatment of latent tuberculosis infection (LTBI) to prevent active tuberculosis (TB) is recommended by the WHO in all HIV-infected patients. The aim of this study was to evaluate its implementation within Belgium's HIV care. A multiple-choice questionnaire was sent to 55 physicians working in the country's AIDS reference centres. Response rate reached 62%. Only 20% screened all their HIV-infected patients for LTBI. Screening methods used and their interpretation vary from one physician to another. The main barriers to the implementation of LTBI screening and treatment, as perceived by the participants, are lack of sensitivity of screening tools, risks associated with polypharmacy and toxicity of treatment. The poor coverage of LTBI screening reported here and the inconsistency in methods used raises concern. However, this was not unexpected as, in low-TB incidence countries, who, when and how to screen for LTBI remains unclear and published guidelines show important disparities. Recently, a targeted approach in which only HIV-infected patients at highest risk of TB are screened has been suggested. Such a strategy would limit unnecessary exposure to LTBI treatment. This methodology was approved by 80% of the participants and could therefore achieve greater coverage. Its clinical validation is still pending.

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Latent tuberculosis screening and treatment among asylum seekers: a mixed-methods study

European Respiratory Journal ◽

10.1183/13993003.00052-2020 ◽

2020 ◽

Vol 55 (4) ◽

pp. 2000052

Author(s):

Simone Villa ◽

Luigi Ruffo Codecasa ◽

Marino Faccini ◽

Mirella Maria Pontello ◽

Maurizio Ferrarese ◽

...

Keyword(s):

Mixed Methods ◽

Asylum Seekers ◽

Latent Tuberculosis ◽

Mixed Methods Study ◽

Tuberculosis Screening

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Latent tuberculosis screening and treatment among asylum seekers: a mixed-methods study

European Respiratory Journal ◽

10.1183/13993003.00475-2020 ◽

2020 ◽

Vol 55 (4) ◽

pp. 2000475

Author(s):

Ineke Spruijt ◽

Connie Erkens ◽

Susan van den Hof ◽

Frank Cobelens

Keyword(s):

Mixed Methods ◽

Asylum Seekers ◽

Latent Tuberculosis ◽

Mixed Methods Study ◽

Tuberculosis Screening

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Knowledge, attitudes, beliefs, and stigma related to latent tuberculosis infection: a qualitative study among Eritreans in the Netherlands

10.21203/rs.3.rs-15581/v1 ◽

2020 ◽

Author(s):

Ineke Spruijt ◽

Dawit Tesfay Haile ◽

Susan van den Hof ◽

Kathy Fiekert ◽

Niesje Jansen ◽

...

Keyword(s):

Asylum Seekers ◽

Cultural Beliefs ◽

Latent Tuberculosis ◽

Treatment Programs ◽

Treatment Cascade ◽

Individual Interviews ◽

Ltbi Screening ◽

Latent Tb Infection ◽

Anticipated Stigma ◽

Asylum Seekers And Refugees

Abstract Background Tailored and culturally appropriate latent tuberculosis (TB) infection screening and treatment programs, including interventions against TB stigma, are needed to reduce TB incidence in low TB incidence countries. However, we lack insights in stigma related to latent TB infection (LTBI) among target groups, such as asylum seekers and refugees. We therefore studied knowledge, attitudes, beliefs and stigma associated with LTBI among Eritrean asylum seekers and refugees in the Netherlands.Methods We interviewed adult Eritrean asylum seekers and refugees: 26 semi-structured group interviews following TB and LTBI related health education and LTBI screening, and 31 semi-structured individual interviews with Eritreans during or after completion of LTBI treatment. We used a thematic analysis to identify, analyse and report patterns in the data.Results Despite TB/LTBI education, misconceptions embedded in cultural beliefs about TB transmission and prevention persisted. Fear of getting infected with TB was the cause of reported enacted (isolation and gossip) and anticipated (concealment of treatment and self-isolation) stigma by participants on LTBI treatment.Conclusion The inability to differentiate LTBI from TB disease and consequent fear of getting infected by persons with LTBI led to enacted and anticipated stigma comparable to stigma related to TB disease among Eritreans. Additional to continuous culturally sensitive education activities, TB prevention programs should implement evidence-based interventions reducing stigma at all phases in the LTBI screening and treatment cascade.

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1391. Latent Tuberculosis Screening Cascade in Liver Transplant Candidates: A Single, Transplant Center Experience

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1255 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S505-S506

Author(s):

Natalia Medvedeva ◽

Harry Cheung ◽

Elizabeth Wootton ◽

Kara Ventura ◽

Marwan M Azar ◽

...

Keyword(s):

Risk Factors ◽

Liver Transplant ◽

Screening Method ◽

Latent Tuberculosis ◽

Post Transplantation ◽

Radiographic Findings ◽

Ltbi Treatment ◽

Ltbi Screening ◽

Transplant Candidates ◽

Test Result

Abstract Background Screening for latent tuberculosis infection (LTBI) is an essential component of the pre-transplant evaluation and key in identifying patients at risk for TB reactivation post-transplantation. At our center, liver transplant candidates (LTC) are routinely referred to transplant infectious disease (TID) for pre-TID evaluation including LTBI screening. Our aim was to determine the effectiveness of our screening practices and identify barriers to LTBI treatment. Methods We conducted a medical chart review of actively wait-listed LTC as of February 18/2019. Data points collected included: TB risk factors, TID referral and completion of evaluation, intention to screen for LTBI (defined as placing an order), screening completion (with documentation of a test result), screening method (IGRA or PPD), screening test result, radiographic findings, and treatment initiation and completion, if applicable. A positive screen was defined as a positive IGRA or PPD result while a negative screen was defined as a negative result or an indeterminate result with lack of epidemiological risk factors and negative radiographic findings. The proportion of LTC who completed each step in the cascade of care for LTBI was determined. Results Of 102 LTC, 100 met inclusion criteria. Two were excluded due to past LTBI treatment. Of 100 LTC, 95 completed a pre-TID evaluation. For 94 (98.9%), there was intention to screen. Of those intended for screening, 91 (95.8%) successfully completed screening; 6 (6.6%) patients screened positive and 85 (93.4%) screened negative. All 6 LTC who tested positive were recommended for treatment. Five of 6 (83.3%) agreed to treatment, 3/6 (50.0%) started treatment, and all 3 completed treatment. Reasons for non-treatment included: deferral until completion of HCV treatment or hepatologist approval or patient refusal. Treatment regimens included rifampin (n = 1) and isoniazid (n = 2). Conclusion The prevalence of LTBI in our LTC cohort was low. Nonetheless, TID played a role in the successful completion of LTBI screening and identifying those appropriate for treatment in this vulnerable patient population. Barriers to successful LTBI screening and treatment completion are contingent on effective care coordination and addressing competing co-morbidities. Disclosures All authors: No reported disclosures.

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Latent tuberculosis screening before kidney transplantation in the South of Brazil

Brazilian Journal of Nephrology ◽

10.1590/2175-8239-jbn-2020-0189 ◽

2021 ◽

Author(s):

Gisele Meinerz ◽

Cynthia Keitel da Silva ◽

Damaris Mikaela Balin Dorsdt ◽

Julia Bertoni Adames ◽

Julio Pasquali Andrade ◽

...

Keyword(s):

Kidney Transplantation ◽

Latent Tuberculosis ◽

Tuberculin Test ◽

Tuberculosis Screening ◽

Post Transplant ◽

Ltbi Screening ◽

Interferon Gamma Release Assays ◽

High Incidence ◽

South Of Brazil

Abstract Background: Tuberculosis (TB) is a prevalent infection after kidney transplantation (KT) in high-burden countries. Latent tuberculosis infection (LTBI) screening includes previous TB history, chest radiograph findings, and tuberculin test (TST) and/or interferon-gamma release assays (IGRAs) results. We aimed to compare our routine LTBI screening of KT candidates and living donors (LD) with their IGRA results, and evaluate if this would improve isoniazid (INH) treatment referral. Methods: We evaluated adult KT candidates and LD with complete routine LTBI screening and QuantiFERON-TB® Gold In-Tube (QFT) testing. Blood samples were collected from April 4th, 2014 to October 31st, 2018, with follow-up until October 31st, 2019. Results: There were 116 KT recipients, with 30% QFT-positive results. Positive QFT was associated with past TB history (p=0.007), positive TST (p<0.0001), residual radiographic lesions (p=0.003), and diabetes (p=0.035). There were 25 LD, 40% had positive QFT. Positive QFT was associated with a positive TST (p=0.002). Positive QFT results increased INH referral in 80%. Post-transplant TB incidence was 2.6% in a median follow-up of 2 (1-33) months. No variables were associated with post-transplant TB. TB patients had inferior, although non-significant, 5-year graft survival (66.7% vs. 76.5%) (p = 0.402). Conclusion: In the present study, the association of QFT to our routine LTBI screening incremented INH treatment referral, but there was still a high incidence of post-transplant TB, possibly related to other forms of infection, such as new exposure and donor transmission.

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