Abstract
Introduction Evidence 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.
Methods We 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.
Results 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 services, language barriers and moving from asylum seeker centres to the community during treatment.
Conclusion 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.
Abstract
LTBI screening and treatment among asylum seekers is feasible and effective when high quality of care is provided, including special attention for culture-sensitive education about TB and LTBI and collaboration with partner organisations http://bit.ly/2Lf6Y1I
Footnotes
This article has supplementary material available from erj.ersjournals.com
Data availability: The data supporting the results of this study were obtained from multiple sources. We received permission from these sources to use the data for this study purpose, including publishing results of the study. However, no permission was sought to publish an anonymous dataset. Therefore, anonymous data supporting the study results can be made available only upon request, upon approval by the Dutch National Tuberculosis Registration Committee.
Author contributions: I. Spruijt wrote the study protocol in collaboration with the other authors, performed data management and analyses, and wrote the manuscript. D. Tesfay Haile conducted and transcribed interviews with Eritrean clients, and supported in qualitative data analyses and interpretation. C. Erkens was daily supervisor of I. Spruijt and approved the study protocol. J. Suurmond supervised the qualitative research of this study. S. van den Hof supervised the epidemiological component of this study and approved the study protocol. F. Cobelens provided input on all aspects of the study process. M. Koenders, P. Kouw, N. van Noort and S. Toumanian were coordinators of the study at their PHS. S. Goosen advised on the study process. All authors read, commented on and approved the final manuscript.
Conflict of interest: I. Spruijt reports grants and other from KNCV Tuberculosis Foundation, during the conduct of the study.
Conflict of interest: D. Tesfay Haile has nothing to disclose.
Conflict of interest: J. Suurmond has nothing to disclose.
Conflict of interest: S. van den Hof has nothing to disclose.
Conflict of interest: M. Koenders has nothing to disclose.
Conflict of interest: P. Kouw has nothing to disclose.
Conflict of interest: N. van Noort has nothing to disclose.
Conflict of interest: S. Toumanian has nothing to disclose.
Conflict of interest: F. Cobelens has nothing to disclose.
Conflict of interest: S. Goosen has nothing to disclose.
Conflict of interest: C. Erkens has nothing to disclose.
Support statement: This work was supported by the Netherlands Organisation for Health Research and Development (ZonMW; grant 50-53000-98-128). Qiagen provided the QuantiFERON-TB Gold Plus kits free of charge. Qiagen read the final manuscript. Neither ZonMW nor Qiagen had a role in the study design, data collection and analysis, decision to publish or preparation of the manuscript. Funding information for this article has been deposited with the Crossref Funder Registry.
- Received April 30, 2019.
- Accepted August 26, 2019.
- Copyright ©ERS 2019
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