Abstract
BackgroundMultidrug-resistant tuberculosis (MDR-TB) is a growing concern in meeting global targets for TB control. In high-income low-TB-incidence countries, a disproportionate number of MDR-TB cases occur in migrant (foreign-born) populations, with concerns about low adherence rates in these patients compared to the host non-migrant population. Tackling MDR-TB in this context may, therefore, require unique approaches. We conducted a systematic review and meta-analysis to identify and synthesise data on MDR-TB treatment adherence in migrant patients to inform evidence-based strategies to improve care pathways and health outcomes in this group.MethodsThis systematic review and meta-analysis was conducted in line with PRISMA guidelines (PROSPERO 42017070756). The databases Embase, MEDLINE, Global Health and PubMed were searched to 24 May 2017 for primary research reporting MDR-TB treatment adherence and outcomes in migrant populations, with no restrictions on dates or language. A meta-analysis was conducted using random-effects models.ResultsFrom 413 papers identified in the database search, 15 studies reporting on MDR-TB treatment outcomes for 258 migrants and 174 non-migrants were included in the systematic review and meta-analysis. The estimated rate of adherence to MDR-TB treatment across migrant patients was 71% [95% confidence interval (CI) = 58–84%], with non-adherence reported among 20% (95% CI = 4–37%) of migrant patients. A key finding was that there were no differences in estimated rates of adherence [risk ratio (RR) = 1.05; 95% CI = 0.82–1.34] or non-adherence (RR = 0.97; 95% CI = 0.79–1.36) between migrants and non-migrants.ConclusionsMDR-TB treatment adherence rates among migrants in high-income low-TB-incidence countries are approaching global targets for treatment success (75%), and are comparable to rates in non-migrants. The findings highlight that only just over 70% of migrant and non-migrant patients adhere to MDR-TB treatment. The results point to the importance of increasing adherence in all patient groups, including migrants, with an emphasis on tailoring care based on social risk factors for poor adherence. We believe that MDR-TB treatment targets are not ambitious enough.
Highlights
Multidrug-resistant tuberculosis (MDR-tuberculosis OR (TB)) is a growing concern in meeting global targets for TB control
Current evidence suggests that Multidrug-resistant tuberculosis (MDR-TB) will increase globally as a proportion of total TB cases, due to transmission of MDR-TB [6, 7], and poor adherence to TB treatment leading to the emergence of MDR-TB [1, 8,9,10,11]
Adherence rates among migrants on treatment for MDR-TB were estimated to be 71%, approaching global treatment adherence targets [12], and exceeding previous reports estimating adherence rates in the general population as 49–63.5% [57, 58]. This raises questions about whether more ambitious targets should be set for MDR-TB treatment adherence globally, and suggests that adherence may be dependent on social risk factors and treatment context, migrant status
Summary
Multidrug-resistant tuberculosis (MDR-TB) is a growing concern in meeting global targets for TB control. In many high-income low-TB-incidence countries, migrant (foreign-born) populations experience a disproportionate burden of TB and MDR-TB [16,17,18] They are suggested to have poorer treatment outcomes, with 5.2% of non-UK-born TB cases notified as being lost to followup, compared to only 1.5% among UK-born TB cases [19]. As a result, they have received close attention in targeted TB initiatives [20, 21], with specific frameworks being drawn up globally to tackle TB and MDR-TB within these communities [22]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
