Latent tuberculosis screening and treatment among asylum seekers: a mixed methods study

Introduction Evidence on conditions for implementation of latent tuberculosis (TB) infection screening and treatment among asylum seekers is needed to inform TB control policies. We used mixed-methods to evaluate the implementation of a latent TB infection (LTBI) screening and treatment program among asylum seekers in the Netherlands. Methods We offered voluntary LTBI screening to asylum seekers aged ≥12 years living in asylum seeker centres from countries with a TB incidence >200/100 000 population. We calculated LTBI screening and treatment cascade coverages and assessed associated factors with Poisson regression using robust variance estimators. We interviewed TB care staff (7 group interviews) and Eritrean clients (21 group and 21 individual interviews) to identify program enhancers and barriers. Results We screened 719 (63% of 1136) clients for LTBI. LTBI was diagnosed among 178 (25%) clients: 149 (84%) initiated LTBI treatment, of whom 129 (87%) completed treatment. In-person TB and LTBI education, the use of professional interpreters, and collaboration with partner organisations were enhancers for LTBI screening uptake. Demand-driven LTBI treatment support by TB nurses enhanced treatment completion. Factors complicating LTBI screening and treatment were having to travel to public health service, language barriers and moving from asylum seeker centres to the community during treatment. Conclusion LTBI screening and treatment of asylum seekers is feasible and effective when high quality of care is provided including culture sensitive TB education throughout the care cascade. Additionally, collaboration with partner organisations, such as agencies responsible for reception and support of asylum seekers, should be in place.