Ineke Spruijt1,2, Dawit Tesfay Haile2, Jeanine Suurmond2, Susan van den Hof3,4, Marga Koenders5, Peter Kouw6, Natascha van Noort7, Sophie Toumanian8, Frank Cobelens9, Simone Goosen10, Connie Erkens3. 1. KNCV Tuberculosis Foundation, The Hague, The Netherlands ineke.spruijt@kncvtbc.org. 2. Dept of Public Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. 3. KNCV Tuberculosis Foundation, The Hague, The Netherlands. 4. National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands. 5. Dept of Tuberculosis Control, Public Health Service Gelderland Zuid, Nijmegen, The Netherlands. 6. Dept of Tuberculosis Control, Public Health Service Flevoland, Lelystad, The Netherlands. 7. Dept of Tuberculosis Control, Public Health Service Region Utrecht, Utrecht, The Netherlands. 8. Dept of Tuberculosis Control, Public Health Service Twente, Enschede, The Netherlands. 9. Dept of Global Health and Amsterdam Institute for Global Health and Development, Amsterdam University Medical Center, Amsterdam, The Netherlands. 10. Netherlands Association of Community Health Services (GGD GHOR Nederland), Utrecht, The Netherlands.
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.
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.
Authors: Ineke Spruijt; Dawit Tesfay Haile; Connie Erkens; Susan van den Hof; Simone Goosen; Andrea Ten Kate; Hewan Teshome; Marja Karels; Marga Koenders; Jeanine Suurmond Journal: BMC Public Health Date: 2020-03-12 Impact factor: 3.295