Enhanced screening for tuberculosis infection among immigrants in southern New Brunswick: A cross-sectional pilot study.

BACKGROUND

In 2021, approximately 77% of active tuberculosis (TB) disease (TBD) cases in Canada were among foreign-born individuals. Less than 3% of TBD cases in Canada are detected through pre-arrival Canadian immigration medical examinations (i.e., chest X-rays), and the remaining 97% are likely due to reactivation of undiagnosed latent TB infection (TBI) post-arrival. In New Brunswick, the proportion of TBD cases among foreign-born individuals gradually increased from about 33% (1/3 individuals) in 2013 to 100% (14/14 individuals) in 2023. The objective of this study was to estimate the prevalence of TBI among immigrants in southern New Brunswick, identify potential predictors for positive TBI screening and assess participant experiences with the pilot TBI screening procedure.

METHODS

A cross-sectional study was conducted from November 2021 to November 2023 among immigrants ≥19 years old who had no history of TBD and were born in a country with a TB incidence rate of ≥40/100,000 population or were referred by healthcare professionals. Participants were recruited through various channels and underwent TBI screening using the interferon-gamma release assay, followed by a survey on their screening experience.

RESULTS

Of the 264 participants, 49 (18.6%) screened positive for TBI. Factors associated with higher odds of screening TBI-positive included birthplace in a "highly to severely endemic" (≥300/100,000 population) TB-incidence country (OR=3.24; 95% CI: 1.07-9.81) and increased age (OR=1.05; 95% CI: 1.01-1.08). Participants rated the pilot TBI screening procedure positively (mean scores ranged from 4.03-4.55 on a five-point Likert scale).

CONCLUSION

Results suggest that immigrants born in countries with TB incidences of ≥300/100,000 population should be considered for screening and treatment of TBI. The pilot TBI screening procedure yielded positive feedback. Further research with a larger sample is recommended.