Journal Article

Implementation of latent tuberculosis infection screening and treatment among newly arriving immigrants in the Netherlands: A mixed methods pilot evaluation

Koenders, Marga, Huisman, Erik, Cobelens, Frank, Toumanian, Sophie, Suurmond, Jeanine, Spruijt, Ineke, van den Hof, Susan, Kouw, Peter, Erkens, Connie

2019

Overview

To reach pre-elimination levels of tuberculosis (TB) incidence in the Netherlands, prevention of TB among immigrants through diagnosis and treatment of latent TB infection (LTBI) is needed. We studied the feasibility of a LTBI screening and treatment program among newly arriving immigrants for national implementation. We used mixed methods to evaluate the implementation of LTBI screening and treatment in five Public Health Services (PHS) among immigrants from countries with a TB incidence >50/100,000 population. We used Poisson regression models with robust variance estimators to assess factors associated with LTBI diagnosis and LTBI treatment initiation and reported reasons for not initiating or completing LTBI treatment. We interviewed five PHS teams using a semi-structured method to identify enhancing and impeding factors for LTBI screening and treatment. We screened 566 immigrants; 94 (17%) were diagnosed with LTBI, of whom 49 (52%) initiated and 34 (69%) completed LTBI treatment. LTBI diagnosis was associated with male gender, higher age group, higher TB incidence in the country of origin and lower level of education. Treatment initiation was associated with PHS (ranging from 29% to 86%), lower age group, longer intended duration of stay in the Netherlands, and lower level of education. According to TB physicians, clients and their consulted physicians in the home country lacked awareness about benefits of LTBI treatment. Furthermore, TB physicians questioned the individual and public health benefit of clients who return to their country of origin within the foreseeable future. Doubt of physicians in both host country and country of origin about individual and public health benefits of LTBI screening and treatment of immigrants hampered treatment initiation: the high initiation proportion in one PHS shows that if TB physicians are committed, the LTBI treatment uptake can be higher.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adolescent / Adult / Age Factors / Age groups / Antitubercular Agents - therapeutic use / BCG / Care and treatment / Child / Child, Preschool / Clients / Diagnosis / Disease control / Diseases / Education / Emigrants and Immigrants - psychology / Emigrants and Immigrants - statistics & numerical data / Feasibility studies / Female / Health Knowledge, Attitudes, Practice / Health Plan Implementation - statistics & numerical data / Health screening / Health services / Humans / Immigrants / Incidence / Infant / Infant, Newborn / Infections / Infectious diseases / Latent Tuberculosis - diagnosis / Latent Tuberculosis - drug therapy / Latent Tuberculosis - epidemiology / Male / Mass Screening - organization & administration / Mass Screening - psychology / Mass Screening - statistics & numerical data / Medical diagnosis / Medical personnel / Medicine and Health Sciences / Methods / Middle Aged / Mixed methods research / Netherlands - epidemiology / Noncitizens / Patient Acceptance of Health Care - statistics & numerical data / Patient compliance / People and Places / Physicians / Physicians - statistics & numerical data / Pilot Projects / Poisson density functions / Population / Prevalence / Public health / Qualitative Research / Regression analysis / Regression models / Retirement benefits / Robustness (mathematics) / Screening / Sex Factors / Statistical analysis / Surveys and Questionnaires - statistics & numerical data / Systematic review / Time Factors / Tuberculin Test - psychology / Tuberculin Test - statistics & numerical data / Tuberculosis / Young Adult