A Cross-Sectional Survey on Professionals to Assess Health Needs of Newly Arrived Migrants in Spain

Atención sanitaria; Migrante; EncuestaAtenció sanitària; Migrant; EnquestaHealthcare; Migrant; SurveyHeightened conflicts and lack of safety due to reasons related to economic, social, ethnic, religious, sexual orientation, political, or nationality matters have increased migratory movements during the last, few decades. Unfortunately, when migrants arrive in new territories, they can face many barriers. For example, in Spain, some migrants have difficulties in accessing health services. The main objective of this study was to describe, from the perspective of social and healthcare professionals, health needs and barriers faced among migrants who recently arrived in Spain when accessing the health system. To accomplish this aim, we carried out a cross-sectional descriptive study using a newly created self-administered questionnaire. Statistical analysis was done using the SPSS 23.00® program. Survey collection was from April 2018 to October 2018, and the cohort comprised a total of 228 professionals. Most participants were females (76%), with an average age of 35 years [interquartile range (IQR) 29.8–43.0]. The most represented profession in the cohort was physician (48%), followed by social care professionals (32%), nursing (11%), and other (8%). Of these individuals, 61% stated having either little or limited knowledge of international migrant health rights, and 94% believed migrants must overcome barriers to receive health services. The four most reported barriers were as follows: language, cultural differences, administrative issues, and fear of being undocumented. Additionally, by order of importance, professionals viewed mental health disorders and infectious diseases as the most common contributors to disease burden in this group. The four most popular strategies implemented by professionals to improve healthcare access further for migrants included intercultural competency training for professionals; access to community health agents; access to translators; and development of health system navigation skills among those newly arrived. Study results suggest that governments should make greater efforts to provide social and healthcare professionals with more effective tools that overcome communication barriers and cultural competence training modules.Research reported in this publication was supported by co-funding from the Third EU Health Program (2014-2020) Project Grants (HP-PJ-2016) under Grant Agreement 738091 (MyHealth Consortium)

Tuberculosis active case finding and management of advanced HIV disease in rural Mozambique

Tuberculosis (TB) and human immunodeficiency Virus (HIV) are considered as major global health concerns. According to the World Health Organization (WHO), TB and HIV are the two infectious diseases causing more deaths worldwide. In 2017 10.0 and 1.8 million people were newly infected by TB and HIV respectively. In the same year 2.1 million people died from these diseases worldwide. In particular, Mozambique is one of the world's regions more hardly affected by these epidemics, with 163,000 new TB cases and 150,000 new HIV infections in 2017. Interdependence between both diseases is high, with 40% of the people living with TB in Mozambique also being HIV positive. One of the major challenges in these regions remains as the low-case detection rates for both pathogens. Active case finding (ACF) strategies have often been used to reduce the number of undetected people living in the community. However, these strategies often fail in their capacity to effectively deploy their interventions in an integrated and cost-effective manner. Innovative strategies are needed to identify these diseases early in the community and improve outcomes of people living with HIV (PLHIV) and TB in sub-Saharan Africa. In 2018 a TB ACF study was implemented in the Manhiça district, Mozambique (population ~180,000). Through this intervention community health workers reached all household and community contacts of every new TB case reported in any of the health centres of the district. Participants were tested for HIV and for TB (Xpert® MTB/RIF Ultra in induced sputum). Participants newly detected with TB were referred to the National Tuberculosis Control Program for clinical evaluation and timely TB treatment initiation. All PLHIV identified to be on treatment received a nonadherence questionnaire, those who reported poor antiretroviral therapy (ART)-adherence or who were ART-naïve were invited to be referred to the Manhiça District Hospital to receive screening of advanced HIV disease (AHD). Patients with AHD (CD4 counts < 200 cells/mm3 or WHO stage 3 or 4), were offered a package of interventions recommended by the WHO including screening, treatment and/or prophylaxis for opportunistic infections, rapid ART initiation and adherence support. Throughout this intervention, all information was collected digitally using electronic case report forms (eCRF) which daily generated large volumes of data. Business Intelligence (BI) tools were used to create a real-time data surveillance platform to monitor the progress of this intervention. The preliminary results of this intervention, together with the data management approach of this study and the view obtained from the implementation of self-reported adherence questionnaires, suggest that potential benefits may lie within the implementation of ACF strategies through an interdisciplinary point of view. Furthermore, due to the strong interdependence between TB and HIV, ACF strategies offer a great platform to implement holistic approaches for epidemiologic control of TB, HIV and other related comorbidities

Tuberculosis active case finding and management of advanced HIV disease in rural Mozambique

Tuberculosis (TB) and human immunodeficiency Virus (HIV) are considered as major global health concerns. According to the World Health Organization (WHO), TB and HIV are the two infectious diseases causing more deaths worldwide. In 2017 10.0 and 1.8 million people were newly infected by TB and HIV respectively. In the same year 2.1 million people died from these diseases worldwide. In particular, Mozambique is one of the world's regions more hardly affected by these epidemics, with 163,000 new TB cases and 150,000 new HIV infections in 2017. Interdependence between both diseases is high, with 40% of the people living with TB in Mozambique also being HIV positive. One of the major challenges in these regions remains as the low-case detection rates for both pathogens. Active case finding (ACF) strategies have often been used to reduce the number of undetected people living in the community. However, these strategies often fail in their capacity to effectively deploy their interventions in an integrated and cost-effective manner. Innovative strategies are needed to identify these diseases early in the community and improve outcomes of people living with HIV (PLHIV) and TB in sub-Saharan Africa. In 2018 a TB ACF study was implemented in the Manhiça district, Mozambique (population ~180,000). Through this intervention community health workers reached all household and community contacts of every new TB case reported in any of the health centres of the district. Participants were tested for HIV and for TB (Xpert® MTB/RIF Ultra in induced sputum). Participants newly detected with TB were referred to the National Tuberculosis Control Program for clinical evaluation and timely TB treatment initiation. All PLHIV identified to be on treatment received a nonadherence questionnaire, those who reported poor antiretroviral therapy (ART)-adherence or who were ART-naïve were invited to be referred to the Manhiça District Hospital to receive screening of advanced HIV disease (AHD). Patients with AHD (CD4 counts < 200 cells/mm3 or WHO stage 3 or 4), were offered a package of interventions recommended by the WHO including screening, treatment and/or prophylaxis for opportunistic infections, rapid ART initiation and adherence support. Throughout this intervention, all information was collected digitally using electronic case report forms (eCRF) which daily generated large volumes of data. Business Intelligence (BI) tools were used to create a real-time data surveillance platform to monitor the progress of this intervention. The preliminary results of this intervention, together with the data management approach of this study and the view obtained from the implementation of self-reported adherence questionnaires, suggest that potential benefits may lie within the implementation of ACF strategies through an interdisciplinary point of view. Furthermore, due to the strong interdependence between TB and HIV, ACF strategies offer a great platform to implement holistic approaches for epidemiologic control of TB, HIV and other related comorbidities