Strategies to reach and motivate migrant communities at high risk for TB to participate in latent tuberculosis infection screening program: a community-engaged mixed methods study among Eritreans

Abstract

Background: In the Netherlands, migrant populations with a high TB incidence are an important target group for TB prevention programs. However, there is a lack of insight in community-engaged strategies to reach and motivate those migrants to participate in a latent TB infection (LTBI) education, screening and treatment program.Methods: In co-creation with Eritrean key figures and TB care staff, we designed and executed six strategies to reach and motivate Eritrean communities to participate in LTBI screening and treatment programs in five regions in the Netherlands. We registered participation in LTBI education and screening, and uptake and completion of LTBI treatment. We used semi-structured group and individual interviews with Eritrean participants and key figures, and TB care staff to identify program facilitators and barriers.Results: Uptake of LTBI education and consequent screening varied between strategies (13% - 75% and 10% - 124% respectively). The program resulted in high treatment initiation and completion (both 97%) among those diagnosed with LTBI. Strategies using face-to-face promotion and targeting smaller groups were most successful. Reported program barriers included: competing priorities in the target group, perceived good health, poor risk perception, and skepticism towards the program purpose. TB staff perceived the program as useful but demanding in terms of human resources.Conclusions: Migrant communities can be successfully reached and motivated for LTBI screening and treatment programs, when sufficient (human) resources are in place and community-members, well connected to and trusted by the community, are engaged in the design and execution of the program.

Knowledge, attitudes, beliefs, and stigma related to latent tuberculosis infection: a qualitative study among Eritreans in the Netherlands

“…The comparability of LTBI and TB-related stigma is in line with a previous study among Chinese immigrants in Canada, which linked LTBI related stigma to limited knowledge about LTBI and confusion with TB disease [17]. Although interviewees experienced felt and enacted stigma, which could impede treatment start and completion [29,30], their strong motivation to prevent becoming sick with TB and complete their treatment resulted in high uptake and completion rates [11,31].…”

“…This qualitative study was part of the TB-ENDPoint project, which studied the implementation, national impact, and cost effectiveness of LTBI screening and treatment among high-TB-risk migrant groups in the Netherlands. This project incorporated three mixed method studies (qualitative and quantitative research methods), which evaluated the implementation of LTBI screening and treatment among 1) immigrants [9], 2) asylum seekers -predominantly Eritreans-living in asylum seeker centres [11], and 3) Eritrean refugees living in communities for maximum ten years [10]. Additional file 1 provides a detailed description of the TB ENDPoint project and definitions of the high TB risk migrant groups (See Additional file 1).…”

“…More particularly, TB burden in the Netherlands is currently highest among Eritrean asylum seekers and refugees with TB incidence rates of 925/100,000 person-years in the first year and 309/100,000 person-years in the fifth year post arrival [8]. Following the need to increase efforts to reduce the TB incidence and the positive results of three implementation studies on LTBI screening and treatment among high TB risk migrants groups [9][10][11], Dutch policy advisors are now debating about expanding the implementation of post-arrival LTBI screening to other subgroups of immigrants and asylum seekers [4].…”

“…Qualitative research methodsSource of dataTB-ENDPoint interviews with Eritrean asylum seekers living in asylum seeker centres in the Netherlands[11] TB-ENDPoint interviews with Eritrean refugees living in communities with a maximum duration of stay in the Netherlands of 10 years[10] Anthropology the education, most participants described LTBI as a condition without symptoms, in which the sleeping, or hidden, bacteria can cause TB disease later in life. However, some described LTBI as an early stage of TB disease, which was characterized by the absence of symptoms.…”

Towards elimination of childhood and adolescent tuberculosis in the Netherlands: an epidemiological time-series analysis of national surveillance data

“…Implementation of LTBI screening and treatment in both immigrants and asylum seekers on arrival in the Netherlands is feasible and effective [35,36]. Adequate resources as well as community engagement involving well-connected and trusted community members as facilitators are needed to reach and motivate this population for LTBI screening and treatment programmes [37]. Radiographic screening for asylum seekers aged <12 years is not effective [38]; therefore, LTBI screening and treatment would be a preferable intervention in this group.…”