Douglas P, Posey D L, Zenner D, Robson J, Abubakar I, Giovinazzo G
Health Services and Policy Division, Department of Immigration and Border Protection, Sydney, New South Wales, Australia.
Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Int J Tuberc Lung Dis. 2017 Jul 1;21(7):737-745. doi: 10.5588/ijtld.17.0019.
Effective tuberculosis (TB) prevention and care for migrants requires population health-based approaches that treat the relationship between migration and health as a progressive, interactive process influenced by many variables and addressed as far upstream in the process as possible. By including capacity building in source countries, pre-migration medical screening has the potential to become an integral component of public health promotion, as well as infection and disease prevention, in migrant-receiving nations, while simultaneously increasing capabilities in countries of origin. This article describes the collaborative experiences of five countries (Australia, Canada, New Zealand, United Kingdom and the United States of America, members of the Immigration and Refugee Health Working Group [IRHWG]), with similar pre-migration screening programmes for TB that are mandated. Qualitative examples of capacity building through IRHWG programmes are provided. Combined, the IRHWG member countries screen approximately 2 million persons overseas every year. Large-scale pre-entry screening programmes undertaken by IRHWG countries require building additional capacity for health care providers, radiology facilities and laboratories. This has resulted in significant improvements in laboratory and treatment capacity, providing availability of these facilities for national public health programmes. As long as global health disparities and disease prevalence differentials exist, national public health programmes and policies in migrant-receiving nations will continue to be challenged to manage the diseases prevalent in these migrating populations. National TB programmes and regulatory systems alone will not be able to achieve TB elimination. The management of health issues resulting from population mobility will require integration of national and global health initiatives which, as demonstrated here, can be supported through the capacity-building endeavours of pre-migration screening programmes.
有效的结核病预防与护理需要基于人群健康的方法，将移民与健康之间的关系视为一个由许多变量影响的渐进式互动过程，并尽可能在该过程的上游加以解决。通过在来源国开展能力建设，移民前医疗筛查有潜力成为接收移民国家促进公共卫生以及预防感染和疾病的一个组成部分，同时增强原籍国的能力。本文描述了五个国家（澳大利亚、加拿大、新西兰、英国和美国，移民与难民健康工作组[IRHWG]成员）在结核病移民前筛查项目方面的协作经验，这些项目都是法定的。文中提供了通过IRHWG项目进行能力建设的定性实例。IRHWG成员国每年在海外共筛查约200万人。IRHWG国家开展的大规模入境前筛查项目需要为医疗服务提供者、放射设施和实验室建设更多能力。这带来了实验室和治疗能力的显著提升，为国家公共卫生项目提供了这些设施的可及性。只要全球健康差距和疾病流行差异存在，接收移民国家的国家公共卫生项目和政策在管理这些移民群体中流行的疾病方面将继续面临挑战。仅靠国家结核病项目和监管系统无法实现消除结核病的目标。管理人口流动带来的健康问题需要整合国家和全球卫生举措，正如本文所示，这可以通过移民前筛查项目的能力建设努力来支持。
