Evaluation of the latent tuberculosis screening and treatment strategy for asylum seekers in Stockholm, Sweden 2015–2018: a record linkage study of the care cascade

Abstract

In many countries with low tuberculosis (TB) incidence (<10/100,000) a high proportion of cases originate from latent TB infection (LTBI) reactivation among migrants from high-incidence countries (≥100/100,000) who have been infected before arrival in the host country [1, 2]. Consequently, LTBI screening and management for migrants is an important intervention to reduce TB incidence in those countries [1, 3, 4].

Cost-effectiveness of the latent tuberculosis screening program for migrants in Stockholm Region

“…Cost-effectiveness of LTBI screening is dependent on patient and provider adherence [ 16 ]. We have previously shown that the present screening strategy is implemented largely according to policy and that patient adherence is high [ 15 ]. Still, this screening strategy is only clearly cost-effective for some subgroups, while it is not cost-effective for others.…”

“…The restrictive policy for LTBI treatment for the age group 20–34 in Stockholm has been questioned and might be seen as conservative compared to other regions of Sweden where treatment is recommended for those up to the age of 35 [ 15 , 29 ] In addition, the cascade of care data collected in this cohort shows high rates of treatment completion rates [ 15 ] which is promising for the effectiveness and cost-effectiveness of LTBI screening. A recent review concluded that effectiveness of LTBI programs in the EU/EEU is largely limited by a weak care cascade when a minority of migrants who are screened complete preventive treatment [ 30 ], which seems not to be a problem in the Stockholm setting.…”

“…The cohort consisted of 5470 screened individuals who could be followed through screening, CXR, referral and visit to specialist care, LTBI treatment initiation and completion through linkages between VeraAsyl and electronic medical records in primary (screening data) and secondary care (treatment data). Details of the screening algorithm, the cohort, the methodology for ascertaining completion of each step of the screening and treatment cascade are reported elsewhere [ 15 ]. There was a statistically significant increase in LTBI positivity in higher age groups and among people from countries with higher TB burden (> 200/100,000) [ 15 ].…”

“…Details of the screening algorithm, the cohort, the methodology for ascertaining completion of each step of the screening and treatment cascade are reported elsewhere [ 15 ]. There was a statistically significant increase in LTBI positivity in higher age groups and among people from countries with higher TB burden (> 200/100,000) [ 15 ]. The empirical values for the parameters used in the present model are listed in appendix 1 in the support material.…”

“… *Only those with epidemiological risk factors are screened **Data reported by Nederby-Öhd et al [ 15 ], Table 1 ***Data are obtained through the same database explained in Nederby-Öhd et al [ 15 ], however, not reported in the article itself † Values are the product of “Referred to TB specialist clinic of those screened positive by IGRA” and “Visit at TB specialist clinic of those referred” in Nederby-Öhd et al [ 15 ], Table 2 ‡ Data reported by Nederby-Öhd et al [ 15 ], Table 2 § Data reported by Nederby-Öhd et al [ 15 ], Table 3 …”