Expert Panel: [ARCHIVED] Tuberculosis Among Migrants

When: Jan. 16, 2017 - Jan. 20, 2017 | Community: MDR-TB Treatment & Prevention  

This Expert Panel is Archived.

While this Expert Panel is no longer active, we invite you to review and recommend past replies and resources. Membership for this Expert Panel is closed, but we hope you'll join us in one of the many communities on GHDonline.

Panelists of Tuberculosis Among Migrants and GHDonline staff

Migrants and internally displaced people are at high risk for tuberculosis infection and disease. They encounter multiple TB risk factors along their migration—at origin, during transit, and once arrived at their destination. Forced displacement is an especially concerning situation, with malnutrition, overcrowding in camps, and disruption of healthcare services a common experience.

The epidemiology of TB among migrants is, however, not well understood due to the challenges in surveying marginalized populations. Further, health systems, policy, and legal frameworks are not developed enough to address the problem satisfactorily. Evidence-based and rights-based interventions—and advocacy for them—are essential to prevent, diagnose and treat TB in migrants.

Join the GHDonline MDR-TB community this week, January 16-20, for a panel discussion to explore theses issues. We look forward to hearing your thoughts across the discussion threads below!

How can health systems be adapted to make them more effective at addressing TB in migrants? Should interventions be rights-based? Evidence-based?

Posted: 19 Jan, 2017   Recommendations: 3   Replies: 4

Good Morning from a gray Geneva! My name is Poonam, I work as migration health programme coordinator at the International Organization for Migration (IOM), and also co-Chair a Working Group on TB and migration at the International Union against TB and Lung Disease (UNION). And as a Panelist for this week's discussions on TB and migration, I will be here today to pose questions, participate in discussions with you and learn also from all.

With the end TB strategy, the Global Plan to end TB and TB related targets in the SDGs 2030 - the international community and national stakeholders have committed to reaching key populations - including migrants and mobile populations, with the appropriate TB prevention, treatment and care.

During the discussions today, we would like to raise issues around national health systems' response in this regard - how can national health systems adapt to ensure they are inclusive of migrants - including (but not limited to) both documented and undocumented migrants, refugees, asylum seekers, internally displaced persons, labour migrants, seasonal cross-border workers, etc.

How can countries develop migrant-inclusive national TB strategic plans, and ensure the underlying principles of the end TB strategy are well respected - for example, Protection and promotion of human rights, ethics and equity? Universal Health Coverage and the principle of 'leave no one behind' should indeed ensure health systems are capable of responding to the health needs of migrants as well as host communities. This requires innovative service delivery models, like mobile clinics; measures to address stigma and discrimination; culturally competent health care professionals and community engagement.

Adapting the end TB strategy to address TB in migrants would require capacity building of health systems - what are the key elements to consider? Are there experiences from your work in countries on what works and what does not? Health systems require the right level of human, financial and institutional capacity to respond to needs of migrants, and often serve hard-to-reach and most vulnerable groups.

A key element is of course building cross-border collaboration - some of you discussed the issues surrounding cross-border continuity of care yesterday. Are there critical gaps that emerged and could be addressed in health systems strengthening to address TB in migrants?

In building health service delivery models and policies that are evidence-based, a key challenge often is the lack of robust evidence on TB burden and risk factors among various migrant populations, especially in mid and high TB burden countries. So should national health systems wait for the right evidence before reaching out with TB services for marginalized or vulnerable migrant groups, such as those in undocumented status or urban refugees or forcefully displaced persons in a protracted conflict?

Some resources included here. More soon!

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What types of international instruments can be used to establish a continuum of care for people moving across borders? What types of policy and legal approaches are necessary to support migrant TB programs?

Posted: 18 Jan, 2017   Recommendations: 2   Replies: 12

I would like to hear from you about establishing continuity of care for people moving across borders. At Migrant Clinicians Network we have been engaged in providing continuity of care services to individuals leaving the US, both voluntarily and involuntarily, for 20 years through a program called Health Network. What we have learned over time is that while the person’s documentation status is of critical importance to some, what are essential for our work are a robust relationship with the national TB programs in the receiving countries and a clear trust relationship with the person moving while under treatment for TB disease. We have supported individuals returning to 111 countries and have developed memoranda of understanding with some programs with whom we have worked for many years, while relying on signed informed consent from the individual returning as entrée to countries unfamiliar with Health Network.

What has been your experience in providing continuity of care to people moving across borders?

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What are the principle risk factors for active Tuberculosis in migrants and how can they be mitigated

Posted: 17 Jan, 2017   Recommendations: 7   Replies: 18

Dear colleagues
I have read with interest the discussion over the last 24 hours or so, on this most fascinating subject of TB among migrants. Already the discussion has moved on from how to measure and analyse TB in migrants, to the complexities that contribute to how migrants present in terms of TB and other health matters but as Kedir Abdulsemed and Elizabeth Glarer contributions have already identified, migration is not a static phenomenon and that the transitory pathways are sometimes just of great a concern as the individual characteristics of the migrant. I have noted also that the discussion thread has not yet really picked up on the “TB carrier status” through latent TB and what this may mean and how we might measure and analyse this in migrants. I would be most interested to hear views from the TB community on this.
For those who do not know me – my area of work is in immigration and while this inevitably involves TB, it is the factors that contribute to “migration health” that interest me most. Noting that while a lot of the discussion has focussed on migration from high to low burden TB countries, it is important to note that most migration happens between high to high burden countries and even when travelling from high to low, the transitory pathways can take migrants back to high!!
In this context I would like to hear what contributors or other experts feel are the principle risk factors for active TB (or reactivation) and how they can be mitigated. Inevitably this will also need to address drug-resistance.
I have posted some publications including a few articles from an excellent series on migration in the 21st century that might stimulate some thinking of health determinants in migrants that might have some influence on risk factors for TB.
My apologies in advance for any delay in responding to your comments, given it is the middle of the night in Australia!! I will get back to you as soon as I can in the morning (my time)
Kind regards, Paul

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How can we best measure and analyze the TB burden among migrants?

Posted: 16 Jan, 2017   Recommendations: 10   Replies: 22

Dear colleagues,

I hope you are doing fine. We are staring our one week panel discussion on a very important topic of TB among migrants. Today we are focusing on measuring and analyzing the burden of TB among migrants. Here we shall discuss both active and latent TB. To my view both are important. Detecting active TB is crucial to ensure early and adequate treatment and breaking the transmission cycle among migrants and avoid possible transmission from migrants to the local communities. We shall also not forget that migrants are not always having a higher TB rates than the local population, but based on the major flow of migrants, it is often the case that TB rates are higher in the country of origin than in the host country. Much less has attention has been paid to timely detection of latent TB which can avert development of the disease should a recent infection occur.

Should the receiving country have a good screening and surveillance system in place, the numerator is well reported, however most often the challenge is to know the denominator to be able to calculate the prevalence or incidence rate.

I will be posting summary of several publications today, but would like to encourage all community members and other panelists to share their views and experiences in measuring and analyzing the TB burden among migrants.

All the best,

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How can we advocate for controlling TB among migrants without stigmatizing them?

Posted: 20 Jan, 2017   Recommendation: 1   Replies: 2

As we enter the last day of our panel discussion, I would like to thank the all the panelists and community members for their contributions to this point.

We have covered a range of topics: how to measure TB among migrants, how to mitigate the risks of TB in these populations, what international instruments, legal and policy approaches can be helpful in establishing a continuum of TB care for migrants, how health systems can be adapted to make them more effective at providing care for migrants with TB.

Many good ideas and examples have emerged from this online conversation. We should now consider how to implement these ideas, recognizing that the decision of a country, state, or locality about how to manage TB among migrants is inherently political. It then follows that the decision to adopt policies to address TB in migrants will require political will.

We also should recognize that xenophobia and anti-immigrant sentiments are growing in many migrant destinations like the United States, Europe and Australia. In this context, raising awareness about the need for comprehensive, humane policies for the management of TB in migrants carries a risk of stigmatizing these groups, which could be counter-productive.

Clearly, some part of the responsibility to develop TB control policies for migrants will fall to us, the people engaged in this panel discussion. So, community members and experts, how should we advocate for migrant communities and better TB care while avoiding stigmatizing these groups in the process?
I've link below to an article from the Chicago Tribune and another from a US media watchdog group that highlights the problem of TB stigma among migrants. I also provide a link to an interesting piece about how xenophobia may be part of something called the "behavioral immune system", which should probably be considered as we think about avoiding stigmatizing migrants.

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