Increased risk of tuberculosis and HIV co-infection for migrants in the Uganda EU/EAA
New research published today in the European Respiratory Journal found that adult migrants in the UK and EU/EEA fare worse on a range of TB outcomes than non-migrants in those countries.
Researchers led by Dr Heinke Kunst, Reader in Respiratory Medicine at Queen Mary University of London and Honorary Consultant in Respiratory Medicine at Barts Health NHS Trust, conducted a systematic review of current evidence on diagnosis of active TB in migrants entering the European Union/European Economic Area (EU/EEA) and UK.
The work, titled "Tuberculosis in adult migrants in Europe: a TBnet consensus statement" was delivered in collaboration with TBnetscientists with key contribution from Professor Christoph Lange, Professor of Respiratory Medicine.
The review included the clinical presentation and diagnostic delay, treatment outcomes of drug sensitive TB, prevalence and treatment outcomes of multidrug/rifampicin-resistant (MDR/RR)-TB and TB/HIV co-infection.
It showed that migrants have an increased risk of extrapulmonary tuberculosis (TB infection that occurs in organs other than the lungs) compared to pulmonary tuberculosis. It also showed that migrants have an increased risk of tuberculosis and HIV co-infection compared to non-migrants.
The findings also showed an increased risk for multi drug-resistant/rifampicin resistant tuberculosis in migrants with TB when compared to non-migrants with TB. Further to this, migrants with drug susceptible tuberculosis (TB which is not resistant to treatment drugs such as rifampicin) had an increased risk for unfavourable treatment outcomes when compared to non-migrants.
This is the first systematic review to show that migrants with tuberculosis in the UK and EU/EAA have worse outcomes compared to non-migrants with tuberculosis. Based on these findings and expert opinions consensus, the researchers provided recommendation statements to guide the management of migrants with tuberculosis in these countries.
Consensus recommendations include screening of migrants for tuberculosis/latent tuberculosis infection (LTBI) according to country data; a minimal package for tuberculosis care in drug susceptible and multidrug/rifampicin drug resistant tuberculosis; implementation of migrant-sensitive strategies; free healthcare and preventive treatment for migrants with HIV co-infection.
Dr Kunst said: “Migrant populations entering Europe have poorer tuberculosis outcomes than native populations. As cases of tuberculosis are rising in Europe, we need urgent robust strategies to strengthen screening, rapid diagnosis, and treatment in these hard-to-reach populations.”
Migrant-sensitive strategies have been shown to be effective to improve migrant health. These include availability of interpreters and language-appropriate written materials, healthcare provider training in culture-sensitive issues, health education of migrants, strengthening community engagement and social support.
Interestingly, there was no evidence on use of migrant sensitive strategies to improve outcomes of migrants with tuberculosis in the UK and EU/EEA. The researchers hope that the findings may influence public health policy nationally and internationally. Migrant sensitive strategies should be included into routine care of migrants not only for migrants with tuberculosis but also those with other infectious diseases such as viral hepatitis.
Tuberculosis research at Queen Mary
This work complements existing tuberculosis research at Queen Mary in migrants and tuberculosis. Dr Kunst has conducted The CATAPULT trial (Treatment of latent tuberculosis infection in migrants in primary care versus secondary care) funded by Barts Charity recently published in the European Respiratory Journal. The trial showed that the treatment of latent tuberculosis infection in recent migrants to the UK can be safely and effectively managed within primary care when compared to specialist secondary care services at a lower cost. Read more.
Dr Kunst has conducted a NIHR funded study on evaluating uptake of latent tuberculosis infection screening in migrants (Uptake, effectiveness and acceptability of routine screening of pregnant migrants for latent tuberculosis infection in antenatal care) and Prof. Adrian Martineau leads a tuberculosis research programme to develop a new diagnostic test for latent tuberculosis infection.
