INFECTION PREVENTION
is rarely accessed by migrants due to restrictions set by healthcare systems or to fear on the part of the migrants that becoming known to the authorities might result in deportation back to the violence they have fled. “Although there is evidence that transmission of TB from migrants to the general population is low – it predominantly occurs between migrants – there is a risk of transmission for both migrants and the native population,” noted Professor Jon S. Friedland of the International Health Unit, Infectious Diseases & Immunity, Imperial College London, UK, who is senior author of the study. “There is a human rights obligation to improve the diagnosis, treatment and prevention of multi-drug resistant TB in migrants.” After analysing the content of several studies on multi-drug resistant TB, the paper recommended a multi-faceted strategy to improve access to services, more consistent pan-European protocols for screening and treatment, and further research to document the level of multi-drug resistant TB infection in the European migrant population. Detailed recommendations included:
l Changing healthcare policies so that there are fewer barriers to migrants with respect to TB screening, diagnosis and treatment. This would not be granting ‘favours’ to migrants; it would be a sound public health policy to reduce the risk of multi-drug resistant TB transmission to other migrants and the wider population.
l Providing better healthcare generally to migrant populations in individual host countries.
l Developing financial and social support mechanisms for migrants who are diagnosed with multi-drug resistant TB.
l Drawing up and adopting pan-European evidence-based guidelines for screening methods and how to implement them in the migrant populations.
l Research is also required to develop a reliable diagnostic test that can detect latent multi-drug resistant TB and to predict the risk of disease re-activation.
l We also need more evidence that can be used to develop guidelines on how to manage multi-drug resistant TB more effectively in migrant populations across Europe.
Friedland concluded that there is a serious “lack of data on effective screening strategies for multi-drug resistant TB or how routine practice should be adapted across diverse health systems in Europe to improve treatment outcomes in migrants at risk of low adherence to TB treatment or with multi-drug resistant TB.”
Closing critical gaps in TB financing
If the threat is to be tackled on a global scale, significant investment will be required for TB
care and prevention. The WHO warned that investment in low- and middle-income countries fell almost US$ 2 billion short of the US$ 8.3 billion needed in 2016. This gap will widen to US$ 6 billion by 2020 if current levels of funding are not increased. Overall, around 84% of the financing available in low- and middle-income countries in 2016 was from domestic sources, but this was mostly accounted for by the BRICS (Brazil, the Russian Federation, India, China and South Africa) group of countries. Other low- and middle- income countries continue to rely heavily on international donor financing, with more than 75% coming from The Global Fund to Fight AIDS, TB and Malaria. In addition, WHO has estimated that at least an extra US$ 1 billion per year is needed to accelerate the development of new vaccines, diagnostics, and medicines. “The resources deployed against TB, the leading infectious killer in the world, are falling short,” said Dr Ariel Pablos-Méndez, assistant administrator for global health, of the US Agency for International Development (USAID) – the leading bilateral funder of the TB response. “Everyone has a part to play in closing the gap. We need universal health coverage, social protection mechanisms,
The resources deployed against TB, the leading infectious killer in the world, are falling short.
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and public health financing in high burden countries. The development aid community needs to step up more investments now, or we will simply not end one of the world’s oldest and deadliest diseases.”
References
1 Public Health England, Tuberculosis in England 2016 report (presenting data to end of 2015), September 2016.
2 Curran, E, ‘TB – healthcare related outbreaks: a problem?’, presentation at Infection Prevention Society annual congress 2016.
3 Davidson, J, ‘TB in healthcare workers in the UK: a cohort analysis 2009–2013’, Thorax doi:10.1136/ thoraxjnl-2015-208026.
4 CDC, ‘Outbreak of Multidrug-Resistant Tuberculosis at a Hospital — New York City, 1991’, 11 June 1993, accessed at:
https://www.cdc.gov/mmwr/ preview/mmwrhtml/
00020788.htm
5 Naidoo S, Jinabhai CC. TB in healthcare workers in KwaZulu-Natal, South Africa. Int J Tuberc Lung Dis. 2006 Jun;10(6):676-82.
https://www.ncbi.nlm.nih.gov/pubmed/16776456
6 Gandhi NR, et al, Nosocomial transmission of extensively drug-resistant tuberculosis in a rural hospital in South Africa, J Infect Dis. 2013 Jan 1;207(1):9-17. doi: 10.1093/infdis/jis631. Epub 2012 Nov 19.
https://www.ncbi.nlm.nih.gov/ pubmed/23166374
7 WHO, Global Tuberculosis Report 2016, 13 October 2016,
http://www.who.int/tb/ publications/global_report/gtbr2016_executive_ summary.pdf?ua=1
8 Hargreaves S, et al, Multidrug-resistant tuberculosis and migration to Europe, Clinical Microbiology and Infection (2016),
http://dx.doi.org/10.1016/j.cmi. 2016.09.009, cited in press release issued by ESCMID,
www.escmid.org<
http://www.escmid.org 30, November 2016.
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