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      Potential benefits of pre-entry health assessment among labor migrants in the CIS context

      research-article
      Boris Sergeyev , Igor Kazanets
      International Journal of Migration, Health and Social Care
      Emerald Publishing
      Migrants, CIS, Tuberculosis, Health assessment

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          Abstract

          Purpose

          Influx of labor migrants into Russia makes it necessary to put TB prevention measures in place, both inside and outside of Russian borders. While inside Russia TB response is premised on testing migrants applying for work or residence permits for diseases of public significance, millions of migrants – specifically, those working without completing necessary paperwork – evade this requirement. In light of that, the purpose of this paper is to propose introducing disease screening in migrant-sending countries, i.e. testing of potential migrants for infectious diseases in local medical institutions certified by Russian authorities.

          Design/methodology/approach

          To support the proposal, the authors provide review of official data on TB prevalence among migrants in Russia as well as publications on international experience with conducting disease screening in migrant-sending countries.

          Findings

          Available studies demonstrate that conducting disease screening programs in migrant-sending countries is associated with earlier detection of TB cases, shorter period of infectiousness and hospitalization, and significant savings in health budget.

          Originality/value

          Taking into account this experience, the authors propose introducing disease screening programs in CIS both under current legal arrangements and with the requirement for labor migrants to produce medical certificate when entering Russia being introduced. The need for trans-border cooperation in assuring positive health outcomes among labor migrants is also highlighted.

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          Most cited references19

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          Screening of immigrants in the UK for imported latent tuberculosis: a multicentre cohort study and cost-effectiveness analysis

          Summary Background Continuing rises in tuberculosis notifications in the UK are attributable to cases in foreign-born immigrants. National guidance for immigrant screening is hampered by a lack of data about the prevalence of, and risk factors for, latent tuberculosis infection in immigrants. We aimed to determine the prevalence of latent infection in immigrants to the UK to define which groups should be screened and to quantify cost-effectiveness. Methods In our multicentre cohort study and cost-effectiveness analysis we analysed demographic and test results from three centres in the UK (from 2008 to 2010) that used interferon-γ release-assay (IGRA) to screen immigrants aged 35 years or younger for latent tuberculosis infection. We assessed factors associated with latent infection by use of logistic regression and calculated the yields and cost-effectiveness of screening at different levels of tuberculosis incidence in immigrants' countries of origin with a decision analysis model. Findings Results for IGRA-based screening were positive in 245 of 1229 immigrants (20%), negative in 982 (80%), and indeterminate in two (0·2%). Positive results were independently associated with increases in tuberculosis incidence in immigrants' countries of origin (p=0·0006), male sex (p=0·046), and age (p<0·0001). National policy thus far would fail to detect 71% of individuals with latent infection. The two most cost-effective strategies were to screen individuals from countries with a tuberculosis incidence of more than 250 cases per 100 000 (incremental cost-effectiveness ratio [ICER] was £17 956 [£1=US$1·60] per prevented case of tuberculosis) and at more than 150 cases per 100 000 (including immigrants from the Indian subcontinent), which identified 92% of infected immigrants and prevented an additional 29 cases at an ICER of £20 819 per additional case averted. Interpretation Screening for latent infection can be implemented cost-effectively at a level of incidence that identifies most immigrants with latent tuberculosis, thereby preventing substantial numbers of future cases of active tuberculosis. Funding Medical Research Council and Wellcome Trust.
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            Cost-effectiveness of tuberculosis control strategies among immigrants and refugees.

            Today, in Western Europe, Canada and the USA, more than half of all new active tuberculosis (TB) cases occur among foreign-born migrants. This article examines the impact of migration from high TB-incidence to low TB-incidence countries, and compares the cost-effectiveness of different TB control strategies. A Medline search was conducted to identify relevant English language publications prior to December 2003. Additional articles were identified from the reference lists from these publications. Despite the high proportion of active cases in low-incidence countries attributable to foreign-born residents, the public health impact is relatively low. Current chest radiograph screening programmes have little impact and are not cost-effective. Screening with sputum culture would improve cost-effectiveness marginally. Treatment of latent infection detected through screening with tuberculin skin testing or chest radiographs may require coercive measures to maximise impact and cost-effectiveness. In contrast, contact tracing, particularly within ethnic communities, appears to be more cost-efficient and less intrusive. In low-incidence countries, screening of migrants at entry has little overall impact and is not a very cost-effective tuberculosis control strategy. More effective alternatives include contact tracing delivered through primary care and increased investment in global tuberculosis control.
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              Is Open Access

              Engaging New Migrants in Infectious Disease Screening: A Qualitative Semi-Structured Interview Study of UK Migrant Community Health-Care Leads

              Migration to Europe - and in particular the UK - has risen dramatically in the past decades, with implications for public health services. Migrants have increased vulnerability to infectious diseases (70% of TB cases and 60% HIV cases are in migrants) and face multiple barriers to healthcare. There is currently considerable debate as to the optimum approach to infectious disease screening in this often hard-to-reach group, and an urgent need for innovative approaches. Little research has focused on the specific experience of new migrants, nor sought their views on ways forward. We undertook a qualitative semi-structured interview study of migrant community health-care leads representing dominant new migrant groups in London, UK, to explore their views around barriers to screening, acceptability of screening, and innovative approaches to screening for four key diseases (HIV, TB, hepatitis B, and hepatitis C). Participants unanimously agreed that current screening models are not perceived to be widely accessible to new migrant communities. Dominant barriers that discourage uptake of screening include disease-related stigma present in their own communities and services being perceived as non-migrant friendly. New migrants are likely to be disproportionately affected by these barriers, with implications for health status. Screening is certainly acceptable to new migrants, however, services need to be developed to become more community-based, proactive, and to work more closely with community organisations; findings that mirror the views of migrants and health-care providers in Europe and internationally. Awareness raising about the benefits of screening within new migrant communities is critical. One innovative approach proposed by participants is a community-based package of health screening combining all key diseases into one general health check-up, to lessen the associated stigma. Further research is needed to develop evidence-based community-focused screening models - drawing on models of best practice from other countries receiving high numbers of migrants.
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                Author and article information

                Contributors
                Journal
                IJMHSC
                10.1108/IJMHSC
                International Journal of Migration, Health and Social Care
                IJMHSC
                Emerald Publishing
                1747-9894
                12 June 2017
                : 13
                : 2
                : 265-276
                Affiliations
                [1]Migration Health Department, IOM, Bureau in Moscow, Moscow, Russia
                Author notes
                Boris Sergeyev can be contacted at: bsergeev@iom.int
                Article
                594650 IJMHSC-11-2015-0047.pdf IJMHSC-11-2015-0047
                10.1108/IJMHSC-11-2015-0047
                c0908bda-ab99-4e98-bcf1-6a2a7c024efb
                © Emerald Publishing Limited
                History
                : 18 November 2015
                : 23 February 2016
                : 11 March 2016
                : 31 March 2016
                : 10 May 2016
                : 20 May 2016
                Page count
                Figures: 2, Tables: 1, Equations: 0, References: 38, Pages: 12, Words: 5755
                Categories
                research-article, Conceptual paper
                cat-HSC, Health & social care
                cat-VG, Vulnerable groups
                cat-IDMG, Inequalities & diverse/minority groups
                cat-SOCY, Sociology
                cat-RES, Race & ethnic studies
                cat-MIN, Minorities
                cat-SOCY, Sociology
                cat-RES, Race & ethnic studies
                cat-MLT, Multiculturalism
                cat-SOCY, Sociology
                cat-RES, Race & ethnic studies
                cat-RIL, Racial identity
                cat-SOCY, Sociology
                cat-WEO, Work, economy & organizations
                cat-LMOV, Labour movements
                Custom metadata
                yes
                yes
                JOURNAL
                included

                Tuberculosis,CIS,Health assessment,Migrants
                Tuberculosis, CIS, Health assessment, Migrants

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