Patient support for tuberculosis patients in low-incidence countries: A systematic review.

Patient support during tuberculosis treatment is expected to be more often available and more customized in low tuberculosis incidence, high-resource settings than in lower-resource settings. The aim of this systematic review is to provide an overview of tuberculosis patient support interventions implemented in low-incidence countries and an evaluation of their effects on treatment-related outcomes as well as their acceptability by patients and providers

Minimum package for cross-border TB control and care in the WHO European region: a Wolfheze consensus statement

The World Health Organization (WHO) European region estimates that more than 400,000 tuberculosis (TB) cases occur in Europe, a large proportion of them among migrants. A coordinated public health mechanism to guarantee TB prevention, diagnosis, treatment and care across borders is not in place. A consensus paper describing the minimum package of cross-border TB control and care was prepared by a task force following a literature review, and with input from the national TB control programme managers of the WHO European region and the Wolfheze 2011 conference. A literature review focused on the subject of TB in migrants was carried out, selecting documents published during the 11-yr period 2001–2011. Several issues were identified in cross-border TB control and care, varying from the limited access to early TB diagnosis, to the lack of continuity of care and information during migration, and the availability of, and access to, health services in the new country. The recommended minimum package addresses the current shortcomings and intends to improve the situation by covering several areas: political commitment (including the implementation of a legal framework for TB cross-border collaboration), financial mechanisms and adequate health service delivery (prevention, infection control, contact management, diagnosis and treatment, and psychosocial support).</br

Adherence by Dutch public health nurses to the national guidelines for tuberculosis contact investigation.

OBJECTIVES: To assess whether public health nurses adhered to Dutch guidelines for tuberculosis contact investigations and to explore which factors influenced the process of identifying contacts, prioritizing contacts for testing and scaling up a contact investigation. METHODS: A multiple-case study (2010-2012) compared the contact investigation guidelines as recommended with their use in practice. We interviewed twice 14 public health nurses of seven Public Health Services while they conducted a contact investigation. RESULTS: We found more individuals to be identified as contacts than recommended, owing to a desire to gain insight into the infectiousness of the index case and prevent anxiety among potential contacts. Because some public health nurses did not believe the recommendations for prioritizing contacts fully encompassed daily practice, they preferred their own regular routine. In scaling up a contact investigation, they hardly applied the stone-in-the-pond principle. They neither regularly compared the infection prevalence in the contact investigation with the background prevalence in the community, especially not in immigrant populations. Nonadherence was related to ambiguity of the recommendations and a tendency to act from an individual health-care position rather than a population health perspective. CONCLUSIONS: The adherence to the contact investigation guidelines was limited, restraining the effectiveness, efficiency and uniformity of tuberculosis control. Adherence could be optimized by specifying guideline recommendations, actively involving the TB workforce, and training public health nurses

Prioritizing contacts for testing according to the classification table as suggested by the national guidelines.

<p>(1 = close contact, 2 = casual contact, 3 = community contact).</p>*<p>Accounting for survival of <i>Mycobacterium tuberculosis</i> (air refreshment and circulation) and ventilation.</p>**<p>Use ‘room’ if the contact have been exposed to the index case within a distance of <1–2 m in this location.</p

Questions of the topic list used to explore how public health nurses identified and prioritized contacts and scaled up a CI.

<p>Questions of the topic list used to explore how public health nurses identified and prioritized contacts and scaled up a CI.</p

Association of scaling up a CI with the number of close, casual and community contacts evaluated and detected with LTBI found in the 14 CIs.

†<p>Tested concurrently with the previous group of contacts.</p>a<p>Scaled up according to guidelines because the decision was based on the prevalence of infection among the close contacts.</p>b<p>Scaled up according to guidelines because the PHN considered the number of close contacts too small to accurately assess the prevalence of infection.</p>c<p>Correctly not scaled up because decision was based on prevalence of infection among the close contacts.</p>d<p>Incorrectly scaled up to casual contacts since no infection was found among the close contacts.</p>e<p>Incorrectly scaled up since casual contacts were tested concurrently with close contacts.</p>f<p>Incorrectly scaled up since casual contact was considered a ‘test case’.</p>g<p>Incorrectly scaled up since casual contacts were anxious.</p>h<p>Scaled up to community contacts according to guidelines because the decision was based on the prevalence of infection among the casual contacts.</p>i<p>Incorrectly scaled up to community contacts since no infection was found among the casual contacts.</p>j<p>Incorrectly not scaled up to community contacts although prevalence of infection among casual contacts was high.</p>k<p>Not scaled up to community contacts because according to PHN there was no well defined group of community contacts.</p

The three steps during a CI according to Dutch national guidelines: identifying contacts, prioritizing contacts, and scaling up a CI.

<p>Abbreviations: CDC: the Centers for Disease Control and Prevention, CI: contact investigation, TB: tuberculosis.</p>*<p>Not further specified in guidelines.</p

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

Background: Tailored and culturally appropriate latent tuberculosis (TB) infection screening and treatment programs, including interventions against TB stigma, are needed to reduce TB incidence in low TB incidence countries. However, we lack insights in stigma related to latent TB infection (LTBI) among target groups, such as asylum seekers and refugees. We therefore studied knowledge, attitudes, beliefs, and stigma associated with LTBI among Eritrean asylum seekers and refugees in the Netherlands. Methods: We used convenience sampling to interview adult Eritrean asylum seekers and refugees: 26 semi-structured group interviews following TB and LTBI related health education and LTBI screening, and 31 semi-structured individual interviews with Eritreans during or after completion of LTBI treatment (November 2016–May 2018). We used a thematic analysis to identify, analyse and report patterns in the data. Results: Despite TB/LTBI education, misconceptions embedded in cultural beliefs about TB transmission and prevention persisted. Fear of getting infected with TB was the cause of reported enacted (isolation and gossip) and anticipated (concealment of treatment and self-isolation) stigma by participants on LTBI treatment. Conclusion: The inability to differentiate LTBI from TB disease and consequent fear of getting infected by persons with LTBI led to enacted and anticipated stigma comparable to stigma related to TB disease among Eritreans. Additional to continuous culturally sensitive education activities, TB prevention programs should implement evidence-based interventions reducing stigma at all phases in the LTBI screening and treatment cascade