scholarly journals Strategies to reach and motivate migrant communities at high risk for TB to participate in latent tuberculosis infection screening program: a community-engaged mixed methods study among Eritreans

2019 ◽  
Author(s):  
Ineke Spruijt ◽  
Dawit Tesfay Haile ◽  
Connie Erkens ◽  
Susan van den Hof ◽  
Simone Goosen ◽  
...  
Keyword(s):  
The Netherlands ◽  
Screening Program ◽  
Latent Tuberculosis ◽  
Good Health ◽  
Target Group ◽  
Care Staff ◽  
Treatment Programs ◽  
Migrant Communities ◽  
Migrant Populations ◽  
Ltbi Screening

Abstract Background: In the Netherlands, migrant populations with a high TB incidence are an important target group for TB prevention programs. However, there is a lack of insight in community-engaged strategies to reach and motivate those migrants to participate in a latent TB infection (LTBI) education, screening and treatment program.Methods: In co-creation with Eritrean key figures and TB care staff, we designed and executed six strategies to reach and motivate Eritrean communities to participate in LTBI screening and treatment programs in five regions in the Netherlands. We registered participation in LTBI education and screening, and uptake and completion of LTBI treatment. We used semi-structured group and individual interviews with Eritrean participants and key figures, and TB care staff to identify program facilitators and barriers.Results: Uptake of LTBI education and consequent screening varied between strategies (13% - 75% and 10% - 124% respectively). The program resulted in high treatment initiation and completion (both 97%) among those diagnosed with LTBI. Strategies using face-to-face promotion and targeting smaller groups were most successful. Reported program barriers included: competing priorities in the target group, perceived good health, poor risk perception, and skepticism towards the program purpose. TB staff perceived the program as useful but demanding in terms of human resources.Conclusions: Migrant communities can be successfully reached and motivated for LTBI screening and treatment programs, when sufficient (human) resources are in place and community-members, well connected to and trusted by the community, are engaged in the design and execution of the program.

scholarly journals Strategies to reach and motivate migrant communities at high risk for TB to participate in a latent tuberculosis infection screening program: a community-engaged mixed methods study among Eritreans

2020 ◽  
Author(s):  
Ineke Spruijt ◽  
Dawit Tesfay Haile ◽  
Connie Erkens ◽  
Susan van den Hof ◽  
Simone Goosen ◽  
...  
Keyword(s):  
The Netherlands ◽  
Human Resources ◽  
Screening Program ◽  
Latent Tuberculosis ◽  
Good Health ◽  
Target Group ◽  
Treatment Programs ◽  
Ltbi Treatment ◽  
Migrant Communities ◽  
Ltbi Screening

Abstract Background: In the Netherlands, migrant populations with a high tuberculosis (TB) incidence are an important target group for TB prevention. However, there is a lack of insight in effective community-engaged strategies to reach and motivate these migrants to participate in latent TB infection (LTBI) screening and treatment programs. Methods: In cocreation with Eritrean key figures and TB staff, we designed and executed six strategies to reach and motivate Eritrean communities to participate in LTBI programs, in five regions in the Netherlands. We registered participation in LTBI education and screening, and LTBI treatment uptake and completion. We used semi-structured group and individual interviews with Eritrean participants, key figures, and TB staff to identify facilitators and barriers. Results: Uptake of LTBI education (13% - 75%) and consequent screening (10% - 124%) varied between strategies. LTBI screening uptake >100% resulted from educated participants motivating others to participate in screening. Two strategies, using face-to-face promotion and targeting smaller groups, were the most successful. The program resulted in high LTBI treatment initiation and completion (both 97%). Reported program barriers included: competing priorities in the target group, perceived good health, poor risk perception, and scepticism towards the program purpose. TB staff perceived the program as useful but demanding in terms of human resources. Conclusions: Eritrean migrant communities can be successfully reached and motivated for LTBI screening and treatment programs, when sufficient (human) resources are in place and community members, well-connected to and trusted by the community, are engaged in the design and execution of the program.

scholarly journals Strategies to reach and motivate migrant communities at high risk for TB to participate in a latent tuberculosis infection screening program: a community-engaged mixed methods study among Eritreans

2020 ◽  
Author(s):  
Ineke Spruijt ◽  
Dawit Tesfay Haile ◽  
Connie Erkens ◽  
Susan van den Hof ◽  
Simone Goosen ◽  
...  
Keyword(s):  
The Netherlands ◽  
Human Resources ◽  
Screening Program ◽  
Latent Tuberculosis ◽  
Good Health ◽  
Target Group ◽  
Treatment Programs ◽  
Ltbi Treatment ◽  
Migrant Communities ◽  
Ltbi Screening

Abstract Background: In the Netherlands, migrant populations with a high tuberculosis (TB) incidence are an important target group for TB prevention. However, there is a lack of insight in effective community-engaged strategies to reach and motivate these migrants to participate in latent TB infection (LTBI) screening and treatment programs. Methods: In cocreation with Eritrean key figures and TB staff, we designed and executed six strategies to reach and motivate Eritrean communities to participate in LTBI programs, in five regions in the Netherlands. We registered participation in LTBI education and screening, and LTBI treatment uptake and completion. We used semi-structured group and individual interviews with Eritrean participants, key figures, and TB staff to identify facilitators and barriers. Results: Uptake of LTBI education (13% - 75%) and consequent screening (10% - 124%) varied between strategies. LTBI screening uptake >100% resulted from educated participants motivating others to participate in screening. Two strategies, using face-to-face promotion and targeting smaller groups, were the most successful. The program resulted in high LTBI treatment initiation and completion (both 97%). Reported program barriers included: competing priorities in the target group, perceived good health, poor risk perception, and scepticism towards the program purpose. TB staff perceived the program as useful but demanding in terms of human resources. Conclusions: Eritrean migrant communities can be successfully reached and motivated for LTBI screening and treatment programs, when sufficient (human) resources are in place and community members, well-connected to and trusted by the community, are engaged in the design and execution of the program.

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

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.

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

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.

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

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.

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

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.

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

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.

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

2019 ◽  
Vol 54 (5) ◽  
pp. 1900861 ◽  
Author(s):  
Ineke Spruijt ◽  
Dawit Tesfay Haile ◽  
Jeanine Suurmond ◽  
Susan van den Hof ◽  
Marga Koenders ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Asylum Seeker ◽  
Asylum Seekers ◽  
Latent Tuberculosis ◽  
Care Staff ◽  
Public Health Services ◽  
Tuberculosis Screening ◽  
Ltbi Treatment ◽  
Treatment Cascade ◽  
Ltbi Screening

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.

scholarly journals Cost-effectiveness of the latent tuberculosis screening program for migrants in Stockholm Region

2021 ◽  
Author(s):  
Jad Shedrawy ◽  
Charlotte Deogan ◽  
Joanna Nederby Öhd ◽  
Maria-Pia Hergens ◽  
Judith Bruchfeld ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Screening Program ◽  
Country Of Origin ◽  
Age Groups ◽  
Latent Tuberculosis ◽  
Cost Effective ◽  
Age Group ◽  
Tuberculosis Screening ◽  
Initiation Rate ◽  
Ltbi Screening

Abstract Introduction The majority of tuberculosis (TB) cases in Sweden occur among migrants from endemic countries through activation of latent tuberculosis infection (LTBI). Sweden has LTBI-screening policies for migrants that have not been previously evaluated. This study aimed to assess the cost-effectiveness of the current screening strategy in Stockholm. Methods A Markov model was developed to predict the costs and effects of the current LTBI-screening program compared to a scenario of no LTBI screening over a 50-year time horizon. Epidemiological and cost data were obtained from local sources when available. The primary outcomes were incremental cost-effectiveness ratio (ICER) in terms of societal cost per quality-adjusted life year (QALY). Results Screening migrants in the age group 13–19 years had the lowest ICER, 300,082 Swedish Kronor (SEK)/QALY, which is considered cost-effective in Sweden. In the age group 20–34, ICER was 714,527 SEK/QALY (moderately cost-effectives) and in all age groups above 34 ICERs were above 1,000,000 SEK/QALY (not cost-effective). ICER decreased with increasing TB incidence in country of origin. Conclusion Screening is cost-effective for young cohorts, mainly between 13 and 19, while cost-effectiveness in age group 20–34 years could be enhanced by focusing on migrants from highest incidence countries and/or by increasing the LTBI treatment initiation rate. Screening is not cost-effective in older cohorts regardless of the country of origin.

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