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Screening for latent tuberculosis infection among undocumented immigrants in Swiss healthcare centres; a descriptive exploratory study.

Bodenmann P, Vaucher P, Wolff H, Favrat B, de Tribolet F, Masserey E, Zellweger JP - BMC Infect. Dis. (2009)

Bottom Line: Twenty-four of the 125 patients (19.2%; CI95% 12.7;27.2) had positive interferon-gamma assay results, two of which had active tuberculosis.Five others initiated the treatment but did not follow through.However, the low adherence to treatment is an important public health concern, and new strategies are needed to address this problem.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland. patrick.bodenmann@hospvd.ch

ABSTRACT

Background: Migration is one of the major causes of tuberculosis in developed countries. Undocumented patients are usually not screened at the border and are not covered by a health insurance increasing their risk of developing the disease unnoticed. Urban health centres could help identify this population at risk. The objective of this study is to assess the prevalence of latent tuberculosis infection (LTBI) and adherence to preventive treatment in a population of undocumented immigrant patients.

Methods: All consecutive undocumented patients that visited two urban healthcare centres for vulnerable populations in Lausanne, Switzerland for the first time were offered tuberculosis screening with an interferon-gamma assay. Preventive treatment was offered if indicated. Adherence to treatment was evaluated monthly over a nine month period.

Results: Of the 161 participants, 131 (81.4%) agreed to screening and 125 had complete examinations. Twenty-four of the 125 patients (19.2%; CI95% 12.7;27.2) had positive interferon-gamma assay results, two of which had active tuberculosis. Only five patients with LTBI completed full preventive treatments. Five others initiated the treatment but did not follow through.

Conclusion: Screening for tuberculosis infection in this hard-to-reach population is feasible in dedicated urban clinics, and the prevalence of LTBI is high in this vulnerable population. However, the low adherence to treatment is an important public health concern, and new strategies are needed to address this problem.

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Adherence to therapy from testing to the end of prophylactic therapies. * Total number of participants with LTBI was expected to be 18. We assumed that the four patients that did not show up for further examination did not have active TB.
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Figure 2: Adherence to therapy from testing to the end of prophylactic therapies. * Total number of participants with LTBI was expected to be 18. We assumed that the four patients that did not show up for further examination did not have active TB.

Mentions: The two patients with active tuberculosis were isolated and treated according to the current Swiss Guidelines [27]. Both were adherent to treatment and were cured. Among the 14 immigrants with no prior history of TB and a positive interferon-γ assay result, four had counter-indications for preventive treatment (high age, liver disease), four did not show up for further examinations, and 10 accepted preventive treatment for LTBI. Of the 10 that accepted preventative treatment, only five followed the treatment until the scheduled completion. Therefore, full treatment was sustained by 5/18 patients with LTBI (Figure 2).


Screening for latent tuberculosis infection among undocumented immigrants in Swiss healthcare centres; a descriptive exploratory study.

Bodenmann P, Vaucher P, Wolff H, Favrat B, de Tribolet F, Masserey E, Zellweger JP - BMC Infect. Dis. (2009)

Adherence to therapy from testing to the end of prophylactic therapies. * Total number of participants with LTBI was expected to be 18. We assumed that the four patients that did not show up for further examination did not have active TB.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2667187&req=5

Figure 2: Adherence to therapy from testing to the end of prophylactic therapies. * Total number of participants with LTBI was expected to be 18. We assumed that the four patients that did not show up for further examination did not have active TB.
Mentions: The two patients with active tuberculosis were isolated and treated according to the current Swiss Guidelines [27]. Both were adherent to treatment and were cured. Among the 14 immigrants with no prior history of TB and a positive interferon-γ assay result, four had counter-indications for preventive treatment (high age, liver disease), four did not show up for further examinations, and 10 accepted preventive treatment for LTBI. Of the 10 that accepted preventative treatment, only five followed the treatment until the scheduled completion. Therefore, full treatment was sustained by 5/18 patients with LTBI (Figure 2).

Bottom Line: Twenty-four of the 125 patients (19.2%; CI95% 12.7;27.2) had positive interferon-gamma assay results, two of which had active tuberculosis.Five others initiated the treatment but did not follow through.However, the low adherence to treatment is an important public health concern, and new strategies are needed to address this problem.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland. patrick.bodenmann@hospvd.ch

ABSTRACT

Background: Migration is one of the major causes of tuberculosis in developed countries. Undocumented patients are usually not screened at the border and are not covered by a health insurance increasing their risk of developing the disease unnoticed. Urban health centres could help identify this population at risk. The objective of this study is to assess the prevalence of latent tuberculosis infection (LTBI) and adherence to preventive treatment in a population of undocumented immigrant patients.

Methods: All consecutive undocumented patients that visited two urban healthcare centres for vulnerable populations in Lausanne, Switzerland for the first time were offered tuberculosis screening with an interferon-gamma assay. Preventive treatment was offered if indicated. Adherence to treatment was evaluated monthly over a nine month period.

Results: Of the 161 participants, 131 (81.4%) agreed to screening and 125 had complete examinations. Twenty-four of the 125 patients (19.2%; CI95% 12.7;27.2) had positive interferon-gamma assay results, two of which had active tuberculosis. Only five patients with LTBI completed full preventive treatments. Five others initiated the treatment but did not follow through.

Conclusion: Screening for tuberculosis infection in this hard-to-reach population is feasible in dedicated urban clinics, and the prevalence of LTBI is high in this vulnerable population. However, the low adherence to treatment is an important public health concern, and new strategies are needed to address this problem.

Show MeSH
Related in: MedlinePlus