CMAJ
Volume 183, Issue 12, 2011, Pages E939-E951

Tuberculosis: Evidence review for newly arriving immigrants and refugees (Review) (Open Access)

Greenaway C.* , Sandoe A. , Vissandjee B. , Kitai I. , Gruner D. , Wobeser W. , Pottie K. , Ueffing E. , Menzies D. , Schwartzman K.
  • a Division of Infectious Diseases and Clinical Epidemiology and Community, SMBD Jewish General Hospital, McGill University, Montréal, QC, Canada
  • b Division of Infectious Diseases and Clinical Epidemiology and Community, SMBD Jewish General Hospital, McGill University, Montréal, QC, Canada
  • c Faculty of Nursing, University of Montreal, Montréal, QC, Canada
  • d Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
  • e Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
  • f Department of Medicine, Division of Infectious Diseases, Queen's University, Kingston, ON, Canada
  • g Institute of Population Health, University of Ottawa, Ottawa, ON, Canada
  • h Institute of Population Health, University of Ottawa, Ottawa, ON, Canada
  • i Montreal Chest Institute, McGill University, Montréal, QC, Canada
  • j Montreal Chest Institute, McGill University, Montréal, QC, Canada

Abstract

Background: The foreign-born population bears a disproportionate health burden from tuberculosis, with a rate of active tuberculosis 20 times that of the non-Aboriginal Canadian-born population, and could therefore benefit from tuberculosis screening programs. We reviewed evidence to determine the burden of tuberculosis in immigrant populations, to assess the effectiveness of screening and treatment programs for latent tuberculosis infection, and to identify potential interventions to improve effectiveness. Methods: We performed a systematic search for evidence of the burden of tuberculosis in immigrant populations and the benefits and harms, applicability, clinical considerations, and implementation issues of screening and treatment programs for latent tuberculosis infection in the general and immigrant populations. The quality of this evidence was assessed and ranked using the GRADE approach (Grading of Recommendations Assessment, Development and Evaluation). Results: Chemoprophylaxis with isoniazid is highly efficacious in decreasing the development of active tuberculosis in people with latent tuberculosis infection who adhere to treatment. Monitoring for hepatotoxicity is required at all ages, but close monitoring is required in those 50 years of age and older. Adherence to screening and treatment for latent tuberculosis infection is poor, but it can be increased if care is delivered in a culturally sensitive manner. Interpretation: Immigrant populations have high rates of active tuberculosis that could be decreased by screening for and treating latent tuberculosis infection. Several patient, provider and infrastructure barriers, poor diagnostic tests, and the long treatment course, however, limit effectiveness of current programs. Novel approaches that educate and engage patients, their communities and primary care practitioners might improve the effectiveness of these programs. © 2011 Canadian Medical Association or its licensors.

Author Keywords

[No Keywords available]

Index Keywords

cultural anthropology patient monitoring immigrant primary medical care refugee human screening test health program liver toxicity Canada latent tuberculosis tuberculosis Review risk benefit analysis patient compliance isoniazid systematic review (topic) systematic review evidence based medicine health care delivery
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-80052544342&doi=10.1503%2fcmaj.090302&partnerID=40&md5=c0a9baefe42291c1886f32c5d161d4c9
DOI: 10.1503/cmaj.090302
ISSN: 08203946
Cited by: 59
Original Language: English