Yield of community-based tuberculosis targeted testing and treatment in foreign-born populations in the United States: A systematic review

Abstract

ObjectiveTo synthesize outputs and outcomes of community-based tuberculosis targeted testing and treatment (TTT) programs in foreign-born populations (FBP) in the United States (US).MethodsWe systematically searched five bibliographic databases and other key resources. Two reviewers independently applied eligibility criteria to screen citations and extracted data from included studies. We excluded studies that contained <50% FBP participants or that examined steps only after diagnosis of latent TB infection (LTBI). We stratified studies as majority FBP (50–90%) and predominantly FBP (>90%). We used random-effects meta-analytic models to calculate pooled proportions and 95% confidence intervals (CI) for community-based TTT cascade steps (e.g., recruited, tested and treated), and used them to create two hypothetical cascades for 100 individuals.ResultsFifteen studies conducted in 10 US states met inclusion criteria. Studies were heterogeneous in recruitment strategies and mostly recruited participants born in Latin America. Of 100 hypothetical participants (predominantly FBP) reached by community-based TTT, 40.4 (95% CI 28.6 to 50.1) would have valid test results, 15.7 (95% CI 9.9 to 21.8) would test positive, and 3.6 (95% CI 1.4 to 6.0) would complete LTBI treatment. Likewise, of 100 hypothetical participants (majority FBP) reached, 77.9 (95% CI 54.0 to 92.1) would have valid test results, 26.5 (95% CI 18.0 to 33.5) would test positive, and 5.4 (95% CI 2.1 to 9.0) would complete LTBI treatment. Of those with valid test results, pooled proportions of LTBI test positive for predominantly FBP and majority FBP were 38.9% (95% CI 28.6 to 49.8) and 34.3% (95% CI 29.3 to 39.5), respectively.ConclusionsWe observed high attrition throughout the care cascade in FBP participating in LTBI community-based TTT studies. Few studies included cascade steps prior to LTBI diagnosis, limiting our review findings. Moreover, Asia-born populations in the US are substantially underrepresented in the FBP community-based TTT literature.

Mortality and Health Outcomes in North Carolina Communities Located in Close Proximity to Hog Concentrated Animal Feeding Operations

“…While no information is currently available on potential risk of occurrence of antibiotic-resistant strains of Mycobacterium tuberculosis in the communities adjacent to hog CAFOs, this aspect may require detailed analysis. The increased risk of undiagnosed latent tuberculosis that may be present in these communities, which may have a higher number of foreignborn residents [45], also requires attention. Co-existence of factors that may promote tuberculosis from its latent to active form (eg, diabetes, immunosuppression, and other conditions) needs to be accounted for when developing a strategy for improving identification of latent and active cases (ie, through screening) and treatment adherence in patients who require therapy.…”

Yield of testing and treatment for tuberculosis among foreign-born persons during contact investigations in the United States: A semi-systematic review

“…In our previous work, we examined the yield of community-based testing programs targeting foreign-born persons who were not known to be contacts of infectious TB cases [ 7 ]. In that work, we found that, for every 100 persons targeted in PFB groups, 40 had valid test results, 16 tested positive, and 5 completed LTBI treatment.…”

“…However, while there are only a few thousand cases of active TB per year in the US, there are millions of persons with LTBI living in the United States, most of whom were infected abroad. Contact investigations alone clearly cannot be relied upon to reach the majority of at-risk foreign-born persons, and must be supplemented with other targeted testing activities, such as community-based targeted testing programs and pre-arrival testing and treatment of US-bound immigrants [ 7 , 29 ], if sustained declines in tuberculosis incidence and prevalence are to be achieved.…”

“…We refer to this study as a “semi-systematic” review because it is an additional analysis of data derived from our systematic review of studies published between 1986 and 2014 examining the yield of community-based TB targeted testing and treatment programs in foreign born populations in the United States [ 7 ]. We used Cochrane Collaboration methods in all aspects of that review [ 8 ].…”

“…Cumulative proportions were products of adjacent-step pooled proportions. Detailed methods for calculation of cumulative proportions have been described elsewhere [ 7 ].…”