Division of Infectious Diseases and Clinical Epidemiology and Community Services Unit, SMBD Jewish General Hospital, McGill University, Montréal, Que. ca.greenaway@mcgill.ca
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.
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).
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.
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.
Notes
Cites: JAMA. 1986 Nov 21;256(19):2729-303773185
Cites: Tubercle. 1987 Mar;68(1):33-83660460
Cites: Am Rev Respir Dis. 1988 Apr;137(4):805-93354985
Cites: N Engl J Med. 1989 Mar 2;320(9):545-502915665
Cites: Pediatr Infect Dis J. 1989 Sep;8(9):649-502640548
Cites: Am J Respir Crit Care Med. 1994 Nov;150(5 Pt 1):1460-27952577
Cites: Pediatr Infect Dis J. 1995 Feb;14(2):144-87746698
Cites: Am J Public Health. 1995 Jun;85(6):786-907762710
Cites: JAMA. 1995 Jul 12;274(2):143-87596002
Cites: Am J Respir Crit Care Med. 1995 Jul;152(1):374-67599848
Cites: CMAJ. 1995 Oct 1;153(7):925-327553494
Cites: Transplantation. 1996 Jan 27;61(2):211-58600625