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

*Corresponding author for this work

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Abstract

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.

Original languageEnglish
Article number17-00543
JournalEurosurveillance (Print)
Volume23
Issue number14
Number of pages21
ISSN1025-496X
DOIs
Publication statusPublished - Apr 2018

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Latent Tuberculosis
European Union
Cost-Benefit Analysis
Interferon-gamma Release Tests
Tuberculin Test
Incidence
Isoniazid
Insurance Benefits
Rifampin
Routine Diagnostic Tests
Public Health
Odds Ratio

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Greenaway, C., Pareek, M., Chakra, C. N. A., Walji, M., Makarenko, I., Alabdulkarim, B., ... 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
Greenaway, Christina ; Pareek, Manish ; Chakra, Claire Nour Abou ; Walji, Moneeza ; Makarenko, Iuliia ; Alabdulkarim, Balqis ; Hogan, Catherine ; McConnell, Ted ; Scarfo, Brittany ; Christensen, Robin ; Tran, Anh ; Rowbotham, Nick ; van der Werf, Marieke J. ; Noori, Teymur ; Pottie, Kevin ; Matteelli, Alberto ; Zenner, Dominik ; Morton, Rachael L. / The effectiveness and cost-effectiveness of screening for latent tuberculosis among migrants in the EU/EEA : A systematic review. In: Eurosurveillance (Print). 2018 ; Vol. 23, No. 14.
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title = "The effectiveness and cost-effectiveness of screening for latent tuberculosis among migrants in the EU/EEA: A systematic review",
abstract = "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.",
author = "Christina Greenaway and Manish Pareek and Chakra, {Claire Nour Abou} and Moneeza Walji and Iuliia Makarenko and Balqis Alabdulkarim and Catherine Hogan and Ted McConnell and Brittany Scarfo and Robin Christensen and Anh Tran and Nick Rowbotham and {van der Werf}, {Marieke J.} and Teymur Noori and Kevin Pottie and Alberto Matteelli and Dominik Zenner and Morton, {Rachael L.}",
year = "2018",
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doi = "10.2807/1560-7917.ES.2018.23.14.17-00543",
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Greenaway, C, Pareek, M, Chakra, CNA, Walji, M, Makarenko, I, Alabdulkarim, B, Hogan, C, McConnell, T, Scarfo, B, Christensen, R, Tran, A, Rowbotham, N, van der Werf, MJ, Noori, T, Pottie, K, Matteelli, A, Zenner, D & Morton, RL 2018, 'The effectiveness and cost-effectiveness of screening for latent tuberculosis among migrants in the EU/EEA: A systematic review', Eurosurveillance (Print), vol. 23, no. 14, 17-00543. https://doi.org/10.2807/1560-7917.ES.2018.23.14.17-00543

The effectiveness and cost-effectiveness of screening for latent tuberculosis among migrants in the EU/EEA : A systematic review. / Greenaway, Christina; Pareek, Manish; Chakra, Claire Nour Abou; Walji, Moneeza; Makarenko, Iuliia; Alabdulkarim, Balqis; Hogan, Catherine; McConnell, Ted; Scarfo, Brittany; Christensen, Robin; Tran, Anh; Rowbotham, Nick; van der Werf, Marieke J.; Noori, Teymur; Pottie, Kevin; Matteelli, Alberto; Zenner, Dominik; Morton, Rachael L.

In: Eurosurveillance (Print), Vol. 23, No. 14, 17-00543, 04.2018.

Research output: Contribution to journalReviewResearchpeer-review

TY - JOUR

T1 - The effectiveness and cost-effectiveness of screening for latent tuberculosis among migrants in the EU/EEA

T2 - A systematic review

AU - Greenaway, Christina

AU - Pareek, Manish

AU - Chakra, Claire Nour Abou

AU - Walji, Moneeza

AU - Makarenko, Iuliia

AU - Alabdulkarim, Balqis

AU - Hogan, Catherine

AU - McConnell, Ted

AU - Scarfo, Brittany

AU - Christensen, Robin

AU - Tran, Anh

AU - Rowbotham, Nick

AU - van der Werf, Marieke J.

AU - Noori, Teymur

AU - Pottie, Kevin

AU - Matteelli, Alberto

AU - Zenner, Dominik

AU - Morton, Rachael L.

PY - 2018/4

Y1 - 2018/4

N2 - 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.

AB - 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.

U2 - 10.2807/1560-7917.ES.2018.23.14.17-00543

DO - 10.2807/1560-7917.ES.2018.23.14.17-00543

M3 - Review

C2 - 29637889

AN - SCOPUS:85045896439

VL - 23

JO - Eurosurveillance

JF - Eurosurveillance

SN - 1025-496X

IS - 14

M1 - 17-00543

ER -