Background Latent tuberculosis infection (LTBI) is one of the most prevalent infections globally and can lead to the development of active tuberculosis disease. In many low-burden countries, LTBI is concentrated within migrant populations often because of a higher disease burden in the migrant's country of origin. National programmes consequently focus on screening and treating LTBI in migrants to prevent future tuberculosis cases; however, how effective these programmes are is unclear. We aimed to assess LTBI treatment initiation and outcomes among migrants, and the factors that influence both.Methods For this systematic review and meta-analysis, we searched Embase, MEDLINE, and Global Health, and manually searched grey literature from Jan 1, 2000, to April 21, 2020. We included primary research articles reporting on LTBI treatment initiation or completion, or both, in migrants and excluded articles in which data were not stratified by migrant status, or in which the data were related to outcomes before 2000. There were no geographical or language restrictions. All included studies were quality appraised using recognised tools depending on their design, and we assessed the heterogeneity of analyses using I². We extracted data on the numbers of migrants initiating and completing treatment. Our primary outcomes were LTBI treatment initiation and completion in migrants (defined as foreign-born). We used random-effects meta-regression to examine the influence of factors related to these outcomes. The study is registered with PROSPERO (CRD42019140338).Findings 2199 publications were retrieved screened, after which 39 publications from 13 mostly high-income, lowburden countries were included in our analyses, with treatment initiation and completion data reported for 31 598 migrants positive for LTBI, with not all articles reporting the full pathway from initiation to completion. The pooled estimate for the true proportion of migrants testing positive who initiated treatment was 69% (95% CI 51-84; I²= 99•62%; 4409 of 8764). The pooled estimate for the true proportion of migrants on treatment in datasets, who subsequently completed it was 74% (95% CI = 66-81; I² = 99•19%; 15 516 of 25 629). Where data were provided for the entire treatment pathway, the pooled estimate for the true proportion of migrants who initiated and completed treatment after a positive test was only 52% (95% CI 40-64; I² = 98•90%; 3289 of 6652). Meta-regression showed that LTBI programmes are improving, with more recent reported data (2010-20) associated with better rates of treatment initiation and completion, with multiple complex factors affecting treatment outcomes in migrants.Interpretation Although our analysis highlights that LTBI treatment initiation and completion in migrants has improved considerably from 2010-20, there is still room for improvement, with drop out reported along the entire treatment pathway. The delivery of these screening and treatment programmes will require further strengthening if the targets to eradicate tuberculosis...

Background Latent Tuberculosis (LTBI) is one of the most prevalent infections globally and is key in development of active tuberculosis disease (TB). In many low-burden countries, LTBI is concentrated within migrant populations reflecting higher disease burden in some countries of origin; national programmes may consequently focus on screening and treating LTBI in migrants to prevent future TB cases. However, little is known about the extent to which migrants initiate treatment for LTBI when testing positive, and their treatment outcomes, which is urgently needed if we are to strengthen these programmes, improve migrant health, and meet TB elimination targets. Methods We did a systematic review and meta-analysis, following PRISMA guidelines and PROSPERO registered (CRD42019140338) to pool global data on LTBI initiation and completion amongst migrants (defined as foreign born), and secondary outcomes to explore the range of both personal and provider level factors associated with initiation and completion. We searched Embase, Medline and Global Health, and hand searched grey literature (from Jan 1 2000 to Apr 21 2020). Inclusion criteria were primary research articles reporting on LTBI treatment initiation and/or completion amongst migrants; we excluded papers where data were not stratified by migrant status, or where the data related to outcomes prior to the year 2000. There were no geographical or language restrictions. Results: 39 publications were included from 13 countries, with treatment initiation and completion data for 31,598 LTBI positive migrants. Overall, 69% (95% CI:51 to 84%; I2:99.62%) of these initiated treatment; 74% (95% CI:66 to 81%; I2;99.19%) of migrants who initiated treatment, completed it; among studies with data on the complete pathway from screening positive to completing treatment, 52% (95% CI:40 to 64%; I2:98.90%) successfully completed treatment. Meta-regression showed that LTBI programmes are improving, with more recent reported data (2010-2020) associated with better rates of treatment initiation and completion. European studies also appeared to have more successful outcomes than those in the Americas and Western Pacific WHO regions. Conclusions: LTBI treatment initiation and completion amongst migrants have room for improvement. Though the data show improvements in the past decade, the delivery of these programmes will need further strengthening if we are to meet targets to eradicate TB in low-incidence countries. Greater focus will need to be placed on engaging migrants more effectively in the clinic and understanding the diverse barriers and facilitators to migrants initiating and completing treatment. Such efforts must be mindful of, and sensitive to the unique experiences individuals arriving in a new country.