Managing tuberculosis infection among migrants from high-incidence tuberculosis countries: challenges, strategies and recommendations

Abstract

Tuberculosis (TB) remains a significant global health challenge, especially in countries with low TB incidence, exacerbated by the influx of migrants from high TB-burden regions. This paper reviews the challenges and strategies for managing TB infection (TBI) among migrants. Challenges in screening and treating TBI among migrants include diagnostic limitations of available tests which are tuberculin skin test (TST) and interferon-gamma release assay (IGRA), socioeconomic barriers, cultural beliefs and mobility. Recommendations vary among guidelines, ranging from proactive screening to targeted approaches. We addressed the issue of two-step testing, discussing the use of an initial TST followed by IGRA confirmation, with consideration of BCG vaccination status and TB exposure history. Treatment options for TBI include isoniazid monotherapy and rifamycin-based regimens in most cases, with varying preferences across guidelines. Challenges in TBI treatment include hepatotoxicity and adherence issues, particularly among migrants. Overall, a comprehensive approach addressing socioeconomic, cultural, and structural factors is crucial for effective TBI management among migrants. Collaboration between healthcare providers, policymakers and migrant communities is essential for developing culturally sensitive screening and treatment protocols. Further research is needed to evaluate the efficacy and feasibility of different screening and treatment strategies, particularly among migrant populations.

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