Just half of migrants with latent TB initiate and complete treatment
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Pooled estimates from a systematic review of nearly 40 studies found that only around half of migrants with latent tuberculosis infection initiated and completed treatment, according to findings reported in The Lancet Infectious Diseases.
The researchers found that among the approximately 70% of migrants who initiated treatment, 3 out of 4 completed it.
“Reactivation of latent tuberculosis infection (LTBI) is a major driver of tuberculosis incidence worldwide; in countries with a low incidence of tuberculosis, LTBI is disproportionately concentrated among migrants, with national programs increasingly focusing on the diagnosis and treatment of LTBI in migrants and other high-risk groups,” Kieran Rustage, MPhil, a PhD student in public health at St. George’s University of London, and colleagues wrote. “However, little is known about the success of these programs in engaging migrants and ensuring treatment completion because migrants often face multiple barriers to accessing health care on arrival in the host country.”
Rustage and colleagues performed a systematic review and meta-analysis of related studies published from Jan. 1, 2000, to April 21, 2020. They selected 39 publications from 13 mostly high-income, low-burden countries for the analysis. The studies included treatment initiation and completion data reported for 31,598 migrants with LTBI, although not all articles reported the full pathway from initiation to completion, the researchers said.
Overall, the pooled estimate for the proportion of migrants with LTBI who initiated treatment was 69% (95% CI, 51%-84%), and the pooled estimate for those who initiated and subsequently completed treatment was 74% (95% CI, 66-81).
Additionally, Rustage and colleagues pooled estimates for the proportion of migrants with LTBI who initiated and completed treatment and found that it was only 52% (95% CI, 40%-64%).
“Although our analysis highlights that LTBI treatment initiation and completion in migrants has improved considerably from 2010 to 2020, there is still room for improvement, with drop out reported along the entire treatment pathway,” the authors wrote. “The delivery of these screening and treatment programs will require further strengthening if the targets to eradicate tuberculosis in low-incidence countries are to be met, with greater focus needed on engaging migrants more effectively in the clinic and understanding the diverse and unique barriers and facilitators to migrants initiating and completing treatment.”
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