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

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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Abstrakt

Background: Migrants account for a large and growing proportion of tuberculosis (TB) cases in lowincidence 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
Artikelnummer17-00543
TidsskriftEurosurveillance (Print)
Vol/bind23
Udgave nummer14
Antal sider21
ISSN1025-496X
DOI
StatusUdgivet - apr. 2018

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Citationsformater

Greenaway, C., Pareek, M., Chakra, C. N. A., Walji, M., Makarenko, I., Alabdulkarim, B., Hogan, C., McConnell, T., Scarfo, B., Christensen, R., Tran, A., Rowbotham, N., van der Werf, M. J., Noori, T., Pottie, K., Matteelli, A., Zenner, D., & Morton, R. L. (2018). The effectiveness and cost-effectiveness of screening for latent tuberculosis among migrants in the EU/EEA: A systematic review. Eurosurveillance (Print), 23(14), [17-00543]. https://doi.org/10.2807/1560-7917.ES.2018.23.14.17-00543