TB prevention in vulnerable populations in low burden countries - PowerPoint PPT Presentation

TB prevention in vulnerable populations in low burden countries

The network

Objectives and approach

Outreach programme of TB screening and strengthen care integration in Romania (WP4) This presentation is part of the project E- DETECT TB (709624) which has received funding from the European Union’s Health Progra mme (2014-2020)

Who to screen? Characteristics TB patients Romania,2017 Total Prisoners Drug users Homeless • Vulnerable populations Estimated population 19.6m 28,000 10,000 5,000-15,000 Number of TB cases 12,310 107 57 117 • Prisoners Estimated TB incidence 500-1500 62.8 382 570 (per 100,000) (Bucharest) • People who use drugs Urban residence 44% 48% 88% 69% • Homeless individuals Previous history of TB 20% 24% 23% 45% HIV infection 2.2% 20% 82% 5.4% • Roma population Drug resistance against 4.6% 4.6% 11.8% 14.0% rifampicine Treatment outcome (2016) - Successful 81% 92% 46% 62% - Died 8.6% 3.7% 25.0% 13.4% This presentation is part of the project E- DETECT TB (709624) which has received funding from the European Union’s Health Progra mme (2014-2020)

Equip mobile digital Training radiography unit (MXU) This presentation is part of the project E- DETECT TB (709624) which has received funding from the European Union’s Health Progra mme (2014-2020)

(10%) Revised algorithm Start treatment TB GeneXpert, on the spot / in the van CAD4TB Human reading 90% ‘abnormal’ Culture (MGIT) in CXR >60 the lab 7% CAD4TB CXR 16% Human GX, ‘subnormal ’ TB reading CXR Culture 51-60 77% CAD4TB ‘normal’ ≤50 This presentation is part of the project E- DETECT TB (709624) which has received funding from the European Union’s Health Progra mme (2014-2020)

Screening main results to date This presentation is part of the project E- DETECT TB (709624) which has received funding from the European Union’s Health Progra mme (2014-2020)

Early LTBI and active TB drtrction in migrants Daniela M. Cirillo 1 and Alberto Matteelli 2 1 IRCCS San Raffaele Scientific Institute , Milano Italy 2 University of Brescia, Brescia, Italy, WHO Collaborating Centre for TB/HIV and TB Elimination This presentation is part of the project E- DETECT TB (709624) which has received funding from the European Union’s Health Progra mme (2014-2020)

WP5 - Mig igrant TB detection, prevention and treatment To create a network with local partners to agree a detailed protocol for migrant screening. To establish active TB screening in temporary migrants in Italy. To start screening for active and latent TB in more settled migrants in Italy. To collect data and produce evidences aiming at impacting European policy. This presentation is part of the project E- DETECT TB (709624) which has received funding from the European Union’s Health Progra mme (2014-2020)

Activ ive TB TB screening strategy This presentation is part of the project E- DETECT TB (709624) which has received funding from the European Union’s Health Progra mme (2014-2020)

Study flow 3867 Screening 900 2967 At least protocol-defined TB symptom No TB symptom 601 299 29 2938 Sputum Collected Sputum NOT Collected Sputum Collected Sputum NOT Collected 159 140 29 557 15 26 3 Sputumcollection Sputumcollection Emptysample Neg Pos Neg Pos notoffered notattend/Refused This presentation is part of the project E- DETECT TB (709624) which has received funding from the European Union’s Health Progra mme (2014-2020)

Considering confirmed cases, estimated screening yield for active TB among asylum seekers is 387 per 100.000 persons Vanino et al; 20172]Active PTBand EPTP. Reception centres, Bologna (Italy) Aldrige at al;2016; active pulmonary TB; UK [3] Pre-entry screening Italian Guidelines on TB screening in migrants; 2010 [4] Schepisi et al, 2016 active pulmonary TB, Italy (Rome, Milan) [5] CARA and CSPA centres in Sicily (Italy) 0 100 200 300 400 500 600 700 800 900 This presentation is part of the project E- DETECT TB (709624) which has received funding from the European Union’s Health Progra mme (2014-2020)

Dia iagnostic ic perf rform rmance of f Xpert MTB TB/RIF vs s Xp Xpert MTB TB/RIF IFUlt ltra compared to MGIT IT cult lture Sensitivity (95% CI) Specificity (95% CI) GeneXpert MTB/RIF-Ultra* 81.82% (52.30-94.86) 98.75% (97.45-99.39) GeneXpert MTB/RIF ^ 54.55% (28.01-78.73) 99.47% (98.46-99.82) This presentation is part of the project E- DETECT TB (709624) which has received funding from the European Union’s Health Progra mme (2014-2020)

Screening for LTBI in a replacement area, Brescia: results of a retrospective analysis 2015-2016 • Retrospective study (2015-2016): TB incidence and prevalence, LTBI rate, screening uptake and treatment completion (LTBI) • Prospective study (2017-2018): TB incidence and prevalence, LTBI rate, screening uptake, treatment completion (LTBI) different health care delivery system (centralized), pilot evaluation of a novel, e-Health recording system This presentation is part of the project E- DETECT TB (709624) which has received funding from the European Union’s Health Progra mme (2014-2020)

Methods: retrospective study (2015-2016) • LTBI screening is offered at a first site , and screening positive individuals are referred to a second site for chest Xray. • LTBI screening was based on the administration of the tuberculin skin test (TST), with 5 IU of PPD • TST was considered positive with induration of >10 mm • Individuals with positive TST and no radiological abnormalities were considered and eventually offered preventive therapy (INH 6Mo). Additional investigation are conducted on a third site This presentation is part of the project E- DETECT TB (709624) which has received funding from the European Union’s Health Progra mme (2014-2020)

Results (data censoring May 2017) 3000 2567 2498 2500 2303 36.6% TST positive 2000 1460 1500 49% screening 1000 843 Completion (TST+) 47.9% started treatment 403 397 500 65% completion rate 190 102 143 93 0 Candidates for LTBI TST performed TST read TST results Screening completed Eligible for treatment Treatment prescribed Treatment outcome AS number LTBI positive treatment not prescribed/treatment outcome screening available This project has received funding from the European Union ’ s Health Programme (2014-2020) under grant agreement No 709624

Brescia: screening for LTBI I in in a replacement area Results of a prospective analysis is 2018 • LTBI screening (TST) performed at a centralized site and asylum seekers are asked to return for reading. • Those with positive TST are immediately tested with IGRA and Chest X-ray performed at the same site. • Those with a positive IGRA and negative chest X-ray are considered for and eventually offered preventive therapy ( HR 3Mo ). 18 This project has received funding from the European Union ’ s Health Programme (2014-2020) under grant agreement No 709624

Screening for LTBI in in a replacement area Results of a prospective analysis is 2018 (8 months) • 144 asylum seekers tested • 141 completed the screening process ✓ Screening pick-up increased by 100% from 49% to 98% • Of 43 eligible asylum seekers 39 initiated treatment ✓ Treatment initiation rate increased by 84% from 48% to 90% 19 This project has received funding from the European Union ’ s Health Programme (2014-2020) under grant agreement No 709624

WP5 - Key achievements to date app based + Xpert ULTRA can be used to screen for active TB among migrants when chest Xray is not feasible incidence of TB among migrants is higher than incidence in Country of Origin, transmission occurs in centers LTBI screening and treatment uptake initially affected by significant losses, mainly attributable to the fragmentation of health care services coupled with the absence of a recording and reporting system Changes in the health care structure allows achieving high screening completion and treatment initiation rates This presentation is part of the project E- DETECT TB (709624) which has received funding from the European Union’s Health Progra mme (2014-2020)

WP6 main objective: Collating, analyzing and evaluating multi country migrant TB screening data Screening for LTBI: Screening for active TB To determine: To determine: - screening coverage - screening coverage, target groups and - results of the initial LTBI reasons for chest X-ray screening screening for active TB - LTBI treatment uptake and completion - results of the initial chest X-ray screening • To estimate reactivation rates of active TB amongst - TB treatment uptake LTBI screening cohort and completion (after the project period). ➢ What approaches are feasible, effective and cost-effective? This presentation is part of the project E- DETECT TB (709624) which has received funding from the European Union’s Health Progra mme (2014-2020)