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

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posted on 31.08.2018, 09:04 by Christina Greenaway, Manish Pareek, Claire-Nour Abou Chakra, Moneeza Walji, Iuliia Makarenko, Balqis Alabdulkarim, Catherine Hogan, Ted McConnell, Brittany Scarfo, Robin Christensen, Anh Tran, Nick Rowbotham, Marieke J. van der Werf, Teymur Noori, Kevin Pottie, Alberto Matteelli, Dominik Zenner, Rachael L. Morton
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.

Funding

This work is supported by the European Centre for Disease Prevention and Control (ECDC); FWC No ECDC/2015/016; Specific Contract No 1 ECD.5748. Dr Manish Pareek is supported by the National Institute for Health Research (NIHR Post-Doctoral Fellowship, Dr Manish Pareek, PDF-2015-08-102). Professor Christensen acknowledges the Parker Institute, Bispebjerg and Frederiksberg Hospital and is supported by a core grant from the Oak Foundation (OCAY-13-309). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. Associate Professor Rachael Morton was supported by an Australian NHMRC Sidney Sax Overseas Fellowship #1054216.

History

Citation

Eurosurveillance, 2018, 23 (14):pii=17- 00543.

Author affiliation

/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Infection, Immunity and Inflammation

Version

VoR (Version of Record)

Published in

Eurosurveillance

Publisher

European Centre for Disease Prevention and Control

eissn

1560-7917

Acceptance date

16/03/2018

Copyright date

2018

Available date

31/08/2018

Publisher version

https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2018.23.14.17-00543

Language

en

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