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Region Hovedstaden - en del af Københavns Universitetshospital
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The effectiveness and cost-effectiveness of screening for latent tuberculosis among migrants in the EU/EEA: a systematic review

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

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  • 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
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BackgroundMigrants 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.

OriginalsprogEngelsk
TidsskriftEurosurveillance
Vol/bind23
Udgave nummer14
ISSN1560-7917
DOI
StatusUdgivet - apr. 2018

ID: 53652365