Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Sherbrooke, Québec, Canada.
Clinique des Réfugiés, Centre Local de Services Communautaires, Sherbrooke, Québec, Canada.
PLoS One. 2022 May 19;17(5):e0267781. doi: 10.1371/journal.pone.0267781. eCollection 2022.
The identification and treatment of latent tuberculosis infection (LTBI) among immigrants from high-incidence regions who move to low-incidence countries is generally considered an ineffective strategy because only ≈14% of them comply with the multiple steps of the 'cascade of care' and complete treatment. In the Estrie region of Canada, a refugee clinic was opened in 2009. One of its goals is LTBI management.
Key components of this intervention included: close collaboration with community organizations, integration within a comprehensive package of medical care for the whole family, timely delivery following arrival, shorter treatment through preferential use of rifampin, and risk-based selection of patients to be treated. Between 2009-2020, 5131 refugees were evaluated. To determine the efficacy and benefit-cost ratio of this intervention, records of refugees seen in 2010-14 (n = 1906) and 2018-19 (n = 1638) were reviewed. Cases of tuberculosis (TB) among our foreign-born population occurring before (1997-2008) and after (2009-2020) setting up the clinic were identified. All costs associated with TB or LTBI were measured.
Out of 441 patients offered LTBI treatment, 374 (85%) were compliant. Adding other losses, overall compliance was 69%. To prevent one case of TB, 95.1 individuals had to be screened and 11.9 treated, at a cost of $16,056. After discounting, each case of TB averted represented $32,631, for a benefit-cost ratio of 2.03. Among nationals of the 20 countries where refugees came from, incidence of TB decreased from 68.2 (1997-2008) to 26.3 per 100,000 person-years (2009-2020). Incidence among foreign-born persons from all other countries not targeted by the intervention did not change.
Among refugees settling in our region, 69% completed the LTBI cascade of care, leading to a 61% reduction in TB incidence. This intervention was cost-beneficial. Current defeatism towards LTBI management among immigrants and refugees is misguided. Compliance can be enhanced through simple measures.
对于从高发地区移民到低发国家的移民，识别和治疗潜伏性结核感染（LTBI）通常被认为是无效的策略，因为只有约 14%的人遵守“关怀链”的多个步骤并完成治疗。在加拿大的埃斯特里地区，2009 年开设了一家难民诊所。其目标之一是管理 LTBI。
该干预措施的关键组成部分包括：与社区组织密切合作，纳入整个家庭医疗保健综合套餐中，在抵达后及时提供服务，通过优先使用利福平缩短治疗时间，并根据风险选择要治疗的患者。2009 年至 2020 年间，对 5131 名难民进行了评估。为了确定该干预措施的疗效和成本效益比，对 2010-14 年（n=1906）和 2018-19 年（n=1638）接受检查的难民的记录进行了回顾。确定了我们的外国出生人口中在开设诊所之前（1997-2008 年）和之后（2009-2020 年）发生的结核病（TB）病例。测量了与 TB 或 LTBI 相关的所有费用。
在 441 名接受 LTBI 治疗的患者中，有 374 名（85%）患者依从性良好。加上其他损失，总依从率为 69%。为了预防 1 例 TB，需要筛查 95.1 人并治疗 11.9 人，费用为 16056 美元。扣除折扣后，每例 TB 被避免的成本为 32631 美元，效益成本比为 2.03。在难民来源的 20 个国家的国民中，TB 的发病率从每 10 万人 68.2 例（1997-2008 年）降至 2009-2020 年的每 10 万人 26.3 例。来自未被干预措施针对的所有其他国家的外国出生者的发病率没有变化。
在我们地区定居的难民中，有 69%的人完成了 LTBI 关怀链，使 TB 发病率降低了 61%。该干预措施具有成本效益。目前对移民和难民 LTBI 管理的失败主义是没有根据的。通过简单的措施可以提高依从性。
