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

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.

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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

10.21203/rs.2.18565/v1 ◽

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.

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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

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/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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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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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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Immigrant screening for latent tuberculosis infection: numbers needed to test and treat, a Norwegian population-based cohort study

BMJ Open ◽

10.1136/bmjopen-2018-023412 ◽

2019 ◽

Vol 9 (1) ◽

pp. e023412 ◽

Cited By ~ 3

Author(s):

Brita Askeland Winje ◽

Gry Marysol Grøneng ◽

Richard Aubrey White ◽

Peter Akre ◽

Preben Aavitsland ◽

...

Keyword(s):

Cohort Study ◽

Latent Tuberculosis Infection ◽

Latent Tuberculosis ◽

Population Based ◽

Tuberculosis Infection ◽

Number Needed To Treat ◽

Ltbi Treatment ◽

Ltbi Screening ◽

Number Needed To Screen ◽

Source Countries

ObjectivesTo estimate the number needed to screen (NNS) and the number needed to treat (NNT) to prevent one tuberculosis (TB) case in the Norwegian immigrant latent tuberculosis infection (LTBI) screening programme and to explore the effect of delay of LTBI treatment initiation.DesignPopulation-based, prospective cohort study.ParticipantsImmigrants to Norway.OutcomeIncident TB.MethodsWe obtained aggregated data on immigration to Norway in 2008–2011 and used data from the Norwegian Surveillance System for Infectious Diseases to assess the number of TB cases arising in this cohort within 5 years after arrival. We calculated the average NNS and NNT for immigrants from the top 10 source countries for TB in Norway and by estimated TB incidence rates in source countries. We explored the sensitivity of these estimates with regard to test performance, treatment efficacy and treatment adherence using an extreme value approach, and assessed the effects of emigration, time to TB diagnosis (to define incident TB) and intervention timing.ResultsNNS and NNT were overall high, with substantial variation. NNT showed numerically stronger negative correlation with TB notification rate in Norway (−0.75 [95% CI −1.00 to −0.44]) than with the WHO incidence rate (IR) (−0.32 [95% CI −0.93 to 0.29]). NNT was affected substantially by emigration and the definition of incident TB. Estimates were lowest for Somali (NNS 99 [70–150], NNT 27 [19–41]) and highest for Thai immigrants (NNS 585 [413–887], NNT 111 [79–116]). Implementing LTBI treatment in immigrants sooner after arrival may improve the effectiveness of the programme.ConclusionUsing TB notifications in Norway, rather than IR in source countries, would improve targeting of immigrants for LTBI management. However, the overall high NNT is a concern and challenges the scale-up of preventive LTBI treatment for significant public health impact. Better data are urgently needed to monitor and evaluate NNS and NNT in countries implementing LTBI screening.

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