The effectiveness and cost-effectiveness of screening for latent tuberculosis among migrants in the EU/EEA: a systematic review

Author:

Greenaway Christina12,Pareek Manish3,Abou Chakra Claire-Nour4,Walji Moneeza1,Makarenko Iuliia1,Alabdulkarim Balqis1,Hogan Catherine12,McConnell Ted1,Scarfo Brittany1,Christensen Robin56,Tran Anh7,Rowbotham Nick7,van der Werf Marieke J8,Noori Teymur8,Pottie Kevin9,Matteelli Alberto10,Zenner Dominik1112,Morton Rachael L.7

Affiliation:

1. Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada

2. Division of Infectious Diseases, Jewish General Hospital, McGill University, Montreal, Canada

3. Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom

4. Division of Infectious Diseases, Sherbrooke, Canada

5. Department of Rheumatology, Odense University Hospital, Denmark

6. Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark

7. National Health and Medical Research Council, NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia

8. European Centre for Disease Prevention and Control, Stockholm, Sweden

9. Bruyere Research Institute, University of Ottawa, Ottawa, Ontario, Canada

10. Clinic of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, World Health Organization Collaborating Centre for TB/HIV and TB Elimination, Brescia, Italy

11. Department of Infection and Population Health, University College London, London, United Kingdom

12. Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom

Abstract

Background Migrants 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.

Publisher

European Centre for Disease Control and Prevention (ECDC)

Subject

Virology,Public Health, Environmental and Occupational Health,Epidemiology

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1. Epidemiology of infectious diseases in migrant populations from endemic or high‐endemic countries: A multicentric primary care‐based study in Spain;Tropical Medicine & International Health;2024-07-19

2. Screening for latent tuberculosis in migrants—status quo and future challenges;International Journal of Infectious Diseases;2024-04

3. Tuberculosis among children visiting friends & relatives;Journal of Travel Medicine;2024-03-04

4. Chapitre 15: Le suivi du rendement du programme de lutte antituberculeuse;Canadian Journal of Respiratory, Critical Care, and Sleep Medicine;2023-11-02

5. Reducing the burden of TB among migrants to low TB incidence countries;The International Journal of Tuberculosis and Lung Disease;2023-03-01

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