Tuberculosis: evidence review for newly arriving immigrants and refugees.
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.


CONCLUSIONS
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.
Greenaway
Christina
C
Division of Infectious Diseases and Clinical Epidemiology and Community Services Unit, SMBD Jewish General Hospital, McGill University, Montréal, Que. ca.greenaway@mcgill.ca
Sandoe
Amelia
A
Vissandjee
Bilkis
B
Kitai
Ian
I
Gruner
Doug
D
Wobeser
Wendy
W
Pottie
Kevin
K
Ueffing
Erin
E
Menzies
Dick
D
Schwartzman
Kevin
K
D002170:Canada / Q000453:epidemiology; D054242:Emigrants and Immigrants; D019317:Evidence-Based Medicine; D006801:Humans; D008403:Mass Screening; D017410:Practice Guidelines as Topic; D012036:Refugees; D014376:Tuberculosis / Q000453:epidemiology* / Q000208:ethnology / Q000517:prevention & control*