Abstract
BackgroundMigrants account for a large and growing proportion of tuberculosis (TB) cases in low-incidence countries in the European Union/European Economic Area (EU/EEA) which are primarily due to reactivation of latent TB infection (LTBI). Addressing LTBI among migrants will be critical to achieve TB elimination. Methods: We conducted a systematic review to determine effectiveness (performance of diagnostic tests, efficacy of treatment, uptake and completion of screening and treatment) and a second systematic review on cost-effectiveness of LTBI screening programmes for migrants living in the EU/EEA. Results: We identified seven systematic reviews and 16 individual studies that addressed our aims. Tuberculin skin tests and interferon gamma release assays had high sensitivity (79%) but when positive, both tests poorly predicted the development of active TB (incidence rate ratio: 2.07 and 2.40, respectively). Different LTBI treatment regimens had low to moderate efficacy but were equivalent in preventing active TB. Rifampicin-based regimens may be preferred because of lower hepatotoxicity (risk ratio = 0.15) and higher completion rates (82% vs 69%) compared with isoniazid. Only 14.3% of migrants eligible for screening completed treatment because of losses along all steps of the LTBI care cascade. Limited economic analyses suggest that the most cost-effective approach may be targeting young migrants from high TB incidence countries. Discussion: The effectiveness of LTBI programmes is limited by the large pool of migrants with LTBI, poorly predictive tests, long treatments and a weak care cascade. Targeted LTBI programmes that ensure high screening uptake and treatment completion will have greatest individual and public health benefit.
Highlights
Tuberculosis (TB) control programmes in the European Union/European Economic area (EU/EEA) have successfully managed to reduce TB rates by 50% over the past 20 years [1,2,3,4]
We sought to answer two research questions: (i) what is the effectiveness of screening migrants arriving or living in the EU/EEA for latent TB infection (LTBI) and (ii) what is the resource use, costs and cost-effectiveness of screening migrants for LTBI? To address these questions, we developed an analytic framework (Figure 1) and the following key questions along the LTBI screening evidence pathway: (i) what are the test properties of LTBI screening tests: tuberculin skin test (TST), interferon gamma release assay (IGRA) or sequential TST/IGRA, (ii) what are the efficacy and harms of LTBI therapies, (iii) what is the uptake of screening and treatment and completion of treatment, Figure 2 PRISMA flow diagram, literature search for the effectiveness and cost-effectiveness of latent tuberculosis screening, 1 January 2005–12 May 2016
Following the GRADE-ADOLOPMENT process, we identified an evidence review that assessed the effectiveness of latent TB infection (LTBI) screening among migrants, published in 2011 by the Canadian Collaboration on Immigrant and Refugee Health (CCIRH), and used this as a starting point for our literature search [16,21]
Summary
Tuberculosis (TB) control programmes in the European Union/European Economic area (EU/EEA) have successfully managed to reduce TB rates by 50% over the past 20 years [1,2,3,4]. The foreign-born population makes up an increasing and considerable number and proportion of all TB cases in EU/EEA countries with a low TB incidence (< 10 cases/100,000 population) [7]. Migrants account for a large and growing proportion of tuberculosis (TB) cases in lowincidence countries in the European Union/European Economic Area (EU/EEA) which are primarily due to reactivation of latent TB infection (LTBI). Targeted LTBI programmes that ensure high screening uptake and treatment completion will have greatest individual and public health benefit
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
