Introduction of short course treatment for latent tuberculosis infection at a primary care facility for refugees in Winnipeg, Canada: A mixed methods evaluation

Barriers and facilitators of tuberculosis treatment among immigrants: an integrative review

BACKGROUND AND OBJECTIVES

Migration, as an important social determinant in the field of health, plays a crucial role in the non-eradication of tuberculosis worldwide. Therefore, it is essential to identify the factors related to tuberculosis treatment in immigrants to effectively combat this disease. However no comprehensive study has focused on this issue. Therefore, this study was conducted using an ecological approach to identify the barriers and facilitators of tuberculosis treatment in immigrants.

METHODS

This qualitative study utilized an integrative literature review. Studies were searched without time restrictions in database such as MEDLINE, Institute for Scientific Information (ISI), Google Scholar, Scopus, and EMBAS, as well as internal databases like Scientific Information Database and Magiran. The findings of 100 studies that met the inclusion criteria were analyzed using the conventional content analysis method based on the ecological approach.

RESULTS

In general, the aforementioned codes were placed into four main categories, including individual factors (i.e., biological factors, psychological factors, behavioral factors, patient knowledge, factors related to tuberculosis, and economic factors), interpersonal factors (i.e., communication with the treatment team and family-related factors), factors related to health service provider centers (i.e., medical facilities), and extra-organizational factors (i.e., social factors and health policies).

CONCLUSION

The findings of the present study show that treating tuberculosis in immigrants is a complex phenomenon influenced by several factors. Therefore policymakers and healthcare providers should take a more comprehensive look at the factors affecting treatment in this group of patients to plan and implement more effective interventions.

Interventions to improve latent and active tuberculosis treatment completion rates in underserved groups in low incidence countries: a scoping review

BACKGROUND

People in underserved groups have higher rates of tuberculosis (TB) and poorer treatment outcomes compared with people with no social risk factors.

OBJECTIVES

This scoping review aimed to identify interventions that improve TB treatment adherence or completion rates.

ELIGIBILITY CRITERIA

Studies of any design focusing on interventions to improve adherence or completion of TB treatment in underserved populations in low incidence countries.

SOURCES OF EVIDENCE

MEDLINE, Embase and Cochrane CENTRAL were searched (January 2015 to December 2023).

CHARTING METHODS

Piloted data extraction forms were used. Findings were tabulated and reported narratively. Formal risk of bias assessment or synthesis was not undertaken.

RESULTS

47 studies were identified. There was substantial heterogeneity in study design, population, intervention components, usual care and definition of completion rates. Most studies were in migrants or refugees, with fewer in populations with other risk factors (eg, homelessness, imprisonment or substance abuse). Based on controlled studies, there was limited evidence to suggest that shorter treatment regimens, video-observed therapy (compared with directly observed therapy), directly observed therapy (compared with self-administered treatment) and approaches that include tailored health or social support beyond TB treatment may lead to improved outcomes. This evidence is mostly observational and subject to confounding. There were no studies in Gypsy, Roma and Traveller populations, or individuals with mental health disorders and only one in sex workers. Barriers to treatment adherence included a lack of knowledge around TB, lack of general health or social support and side effects. Facilitators included health education, trusted relationships between patients and healthcare staff, social support and reduced treatment duration.

CONCLUSIONS

The evidence base is limited, and few controlled studies exist. Further high-quality research in well-defined underserved populations is needed to confirm the limited findings and inform policy and practice in TB management. Further qualitative research should include more people from underserved groups.

Community treatment of latent tuberculosis in child and adult refugee populations: outcomes and successes

Background

Tuberculosis (TB) is the world's leading infectious cause of death, killing millions every year. In Canada, considered a low-incidence country for TB, the burden of the disease is unequally distributed, with most cases of latent tuberculosis infection (LTBI) experienced by newcomers from endemic regions. The purpose of this study was to measure LTBI treatment acceptance and completion outcomes of LTBI treatment at the REACH clinic in Saskatoon, a local refugee clinic providing primary care-based LTBI management.

Methods

A retrospective case series by sampling methodology was applied to review patients who visited the REACH clinic between January 2017 and June 2021 and who had an interferon-gamma release assay (IGRA) or tuberculin skin test (TST) done for LTBI screening. Those with positive results were retained for analysis. The LTBI treatment acceptance and completion groups were compared according to demographic variables, WHO regions of origin, year of arrival to Canada, and LTBI treatment regimen.

Results

A total of 523 patients were screened for LTBI, of whom 125 tested positive, leading to a test positivity of 23.9%. The treatment acceptance rate was 84.8%, and the treatment completion rate was 93.3%. All of those who declined treatment were more than 18 years of age (p = 0.02). Otherwise, treatment acceptance and completion rates did not vary significantly in association with gender, categories of refugees, WHO region of origin, year of arrival to Canada, or LTBI treatment regimen used.

Discussion

The refugee clinic acceptance and completion rates in this study are high and meet Canadian TB standards of care. The multidisciplinary clinic model and community support are important facilitators, which, in combination with shorter treatment regimens, offer a path forward for LTBI management among refugees resettling in low-incidence countries.