Abstract
BackgroundIn 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.MethodsIn 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.ResultsUptake 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.ConclusionsEritrean 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.
Highlights
In the Netherlands, migrant populations with a high tuberculosis (TB) incidence are an important target group for TB prevention
Quantitative results We estimated to reach a total of 904 Eritrean migrants through all strategies employed in the five Public Health Services (PHS) settings
The uptake of latent TB infection (LTBI) education differed between strategies from 13% (Strategy 3.3) to 75% (Strategy 5) (Table 3)
Summary
In the Netherlands, migrant populations with a high tuberculosis (TB) incidence are an important target group for TB prevention. To stimulate further decreases in TB incidence, prevention of TB through screening and treatment of latent TB infection (LTBI) among high-risk migrants is suggested as a strategy for low TB incidence countries [4, 5]. Dutch TB policy advisors are considering to replace current mandatory radiological TB entryscreening among migrants by LTBI screening and treatment [4]. This policy change does not target the large pool of persons with LTBI among settled migrants, who account for 60% of annual TB patients [8]. One can argue that this group of settled, high-TB-risk migrants can be considered as a target group for TB prevention
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