Abstract
BackgroundThe important increase in immigration during recent years has changed the epidemiology and control strategies for tuberculosis (TB) in many places. This study evaluates the effectiveness of intervention with community health workers (CHW) to improve contact tracing among immigrants.MethodsThe study included all TB cases detected by the Barcelona TB Program from 2000 to 2005 and compared a period without CHW intervention (2000-2002) to a period with CHW intervention (2003-2005). The influence on contact tracing of sex, age, hospital of diagnosis, district of residence, birthplace, HIV, homeless and CHW intervention was analysed by logistic regression. Odds ratio (OR) and 95% confidence intervals (CI) were calculated.Results960 foreign born TB cases were detected, 388 in the intervention period. Contact tracing was performed on 65,7% of 201 smear-positive cases during the pre-intervention period compared to 81.6% of 152 smear-positive TB cases during the intervention period (p < 0.001). Risk factors associated with incomplete contact tracing of smear-positive index cases included being diagnosed in two hospitals without contact tracing TB unit (OR = 3.5; CI:1.4-8.9) and (OR = 4.6; CI:1.6-13.5) respectively, birth place in India-Pakistan (OR = 4.4; CI:1.9-10.3) or North Africa (OR = 4.3; CI:1.8-10.5), having an unknown residence (OR = 5.4; CI:1.6-18.0), being HIV-infected (OR = 6.1; CI:2.5-14.8) or homeless (OR = 3.3; CI:1.3-8.2), and the absence of CHW intervention (OR = 2.4; CI:1.3-4.3).ConclusionsThe effectiveness of contact tracing for TB control in areas with high immigration can be improved by incorporating CHWs who act as translators, cultural mediators and facilitators who accompany cases and contacts through treatment and follow-up.
Highlights
The important increase in immigration during recent years has changed the epidemiology and control strategies for tuberculosis (TB) in many places
Variables The study of associated factors involved in performing contact tracing included socio-demographic characteristics (sex, age, hospital of diagnosis: all hospitals had diagnostic services and performed patient monitoring, but hospitals B and D had no contact tracing team and these were refered to their respective general practitioner (GP); geographical area of origin and district of residence), risk factors, clinical data and use of community health workers (CHW) intervention
The healthcare team evaluates the need for CHW intervention depending on the specific problems presented by patients and each case is assigned to a public health nurses (PHN) and to a CHW, depending on their birthplace, language, culture and any other needs of cases and their contacts
Summary
The important increase in immigration during recent years has changed the epidemiology and control strategies for tuberculosis (TB) in many places. In January 2010, 5.7 million of foreign-born persons were registered in Spain (12.2% of the total population), in 1999 were registered 748.953 (1.8% of the total population), this representing an increase of over three million people in eleven years [4]. These percentages have been even higher in large cities such as Barcelona or Madrid, where the immigrant population has reached 17.6% and 17.1%, respectively [5,6]
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