Eliminating latent tuberculosis in low-burden settings: are the principal beneficiaries to be disadvantaged groups or the broader population?

Degeling, Chris; Denholm, Justin T.; Mason, Paul H.; Kerridge, Ian; Dawson, Angus

doi:10.1136/medethics-2016-103424

Cited by 7 publications

(12 citation statements)

References 24 publications

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“…This Australian study is one of the first conducted in a low‐incidence setting to identify the perspectives of migrant groups towards latent tuberculosis screening. There are complex epidemiological, ethical and social dimensions associated with LTBI screening that make understanding the perspectives of those who would be targeted essential to identify and address potential harms 10,11 . For members of Indian and Pakistani communities living in Australia, information provision and targeting rationale are an essential preamble to LTBI screening.…”

Section: Discussionmentioning

confidence: 99%

“…Prognostic ambiguity means that LTBI has different ethical and policy implications to active TB disease 10 . LTBI screening can trigger a complex cascade of testing, information provision, further diagnostic work‐up and preventive therapy in someone who feels perfectly well and may never have progressed to active disease 11,12 . TB elimination programs that offer comprehensive LTBI treatment can cause long‐term physical harm through unpredicted complications, create significant economic burdens 13 and potentially stigmatise treatment recipients in their communities.…”

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confidence: 99%

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Insights into culturally appropriate latent tuberculosis infection (LTBI) screening in NSW: perspectives of Indian and Pakistani migrants

Hall

Kabir

Shih

et al. 2020

Australian and New Zealand Journal of Public Health

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Objective: Latent tuberculosis (LTBI) case-finding and treatment are a focus of TB elimination in Australia. We sought the perspectives of migrants from two high-burden countries likely to be targeted by this strategy. Methods: To understand perceptions of migrant groups in Australia on LTBI screening, 28 in-depth interviews were conducted with Indian and Pakistani community members recruited purposively through local organisations in the Illawarra region, New South Wales. Drawing on local TB policy, data collected qualitatively was analysed using framework methodologies. Results: Australia's immigration system prioritises migrants of higher socioeconomic status. Participants supported elimination but perceived TB as a disease of the poor and not relevant to them. Lack of understanding of LTBI and sensitivity to being 'targeted' are further barriers to screening participation. Conclusion: Information provision and targeting rationale are an essential preamble to LTBI screening. Migration appears to modify cultural attitudes to TB, but not significantly. Despite less stigma surrounding TB in Australian contexts, testing privacy and confidentiality, and limiting public identification of specific groups remain important to program acceptability. Implications for public health: Progress towards TB elimination can be enhanced by consulting with targeted communities, using existing networks for communication and service provision; emphasising prevention benefits.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Insights into culturally appropriate latent tuberculosis infection (LTBI) screening in NSW: perspectives of Indian and Pakistani migrants

Hall

Kabir

Shih

et al. 2020

Australian and New Zealand Journal of Public Health

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“…As outlined above, the implementation of TB screening often results in conflicting interests and creates a tension between the obligation of the state to protect the health of the public on one hand, and respecting the autonomy, health interests, and liberty of the screened individuals on the other. Screening also creates obligations on the screener to ensure that participants are properly supported and have pathways to address detected abnormalities [78]. Screening should only be undertaken with the intention to treat and with an appropriate level of counselling ahead of such screening.…”

Section: Racial Vilificationmentioning

confidence: 99%

“…Migrants often come from countries with weak health systems so may not trust providers or be encultured to seek professional health advice [65]. To engender trustworthiness, there is a need for clarity from service providers as to whom any migration-related screening programme is designed to benefit and the rationale underpinning decisions about how resulting burdens are distributed [78]. When considering the benefits and burdens of TB screening, the potential for stigma must be a key concern.…”

Section: Racial Vilificationmentioning

confidence: 99%

Tuberculosis in migrants – screening, surveillance and ethics

et al. 2020

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Tuberculosis (TB) is the leading infectious cause of human mortality and is responsible for nearly 2 million deaths every year. It is often regarded as a 'silent killer' because it predominantly affects the poor and marginalized, and disease outbreaks occur in 'slow motion' compared to Ebola or coronavirus 2 (COVID-19). In low incidence countries, TB is predominantly an imported disease and TB control in migrants is pivotal for countries to progress towards TB elimination in accordance with the World Health Organisations (WHO's) End TB strategy. This review provides a brief overview of the different screening approaches and surveillance processes that are in place in low TB incidence countries. It also includes a detailed discussion of the ethical issues related to TB screening of migrants in these settings and the different interests that need to be balanced. Given recognition that a holistic approach that recognizes and respects basic human rights is required to end TB, the review considers the complexities that require consideration in low-incidence countries that are aiming for TB elimination.

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“…Possible reasons for undertreatment of LTBI include physicians' uncertainty about whether the benefit of treatment outweighs the risks [ 9 ] and a perception that LTBI treatment in individuals with LTBI may be beneficial from a public health perspective, but not necessarily from an individual patient's perspective [ 10 ]. There is also misinformation, such as the assumption that bacille Calmette–Guérin vaccination offers good protection from developing TB [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Physicians' perspectives on communication and decision making in clinical encounters for treatment of latent tuberculosis infection

2018

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The aim of the study was to explore the views of tuberculosis (TB) physicians on treatment of latent TB infection (LTBI), focusing on decision making and communication in clinical practice.20 Australian TB physicians participated in a semistructured interview in person or over the telephone. Interviews were recorded, transcribed and analysed thematically.The study identified challenges that physicians face when discussing treatment for LTBI with patients. These included difficulties explaining the concept of latency (in particular to patients from culturally and linguistically diverse backgrounds) and providing guidance to patients while still framing treatment decisions as a choice. Tailored estimates of the risk of developing TB and the risk of developing an adverse effect from LTBI treatment were considered the most important information for decision making and discussion with patients. Physicians acknowledged that there is a significant amount of unwarranted treatment variation, which they attributed to the lack of evidence about the risk–benefit balance of LTBI treatment in certain scenarios and guidelines that refer to the need for case-by-case decision making in many instances.In order to successfully implement LTBI treatment at a clinical level, consideration should be given to research on how to best address communication challenges arising in clinical encounters.

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Eliminating latent tuberculosis in low-burden settings: are the principal beneficiaries to be disadvantaged groups or the broader population?

Cited by 7 publications

References 24 publications

Insights into culturally appropriate latent tuberculosis infection (LTBI) screening in NSW: perspectives of Indian and Pakistani migrants

Insights into culturally appropriate latent tuberculosis infection (LTBI) screening in NSW: perspectives of Indian and Pakistani migrants

Tuberculosis in migrants – screening, surveillance and ethics

Physicians' perspectives on communication and decision making in clinical encounters for treatment of latent tuberculosis infection

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