Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Medicine
Published in: BMC Medicine 1/2018

Open Access 01-12-2018 | Research article

Multidrug-resistant tuberculosis treatment adherence in migrants: a systematic review and meta-analysis

Authors: Laura B. Nellums, Kieran Rustage, Sally Hargreaves, Jon S. Friedland

Published in: BMC Medicine | Issue 1/2018

Login to get access

Abstract

Background

Multidrug-resistant tuberculosis (MDR-TB) is a growing concern in meeting global targets for TB control. In high-income low-TB-incidence countries, a disproportionate number of MDR-TB cases occur in migrant (foreign-born) populations, with concerns about low adherence rates in these patients compared to the host non-migrant population. Tackling MDR-TB in this context may, therefore, require unique approaches. We conducted a systematic review and meta-analysis to identify and synthesise data on MDR-TB treatment adherence in migrant patients to inform evidence-based strategies to improve care pathways and health outcomes in this group.

Methods

This systematic review and meta-analysis was conducted in line with PRISMA guidelines (PROSPERO 42017070756). The databases Embase, MEDLINE, Global Health and PubMed were searched to 24 May 2017 for primary research reporting MDR-TB treatment adherence and outcomes in migrant populations, with no restrictions on dates or language. A meta-analysis was conducted using random-effects models.

Results

From 413 papers identified in the database search, 15 studies reporting on MDR-TB treatment outcomes for 258 migrants and 174 non-migrants were included in the systematic review and meta-analysis. The estimated rate of adherence to MDR-TB treatment across migrant patients was 71% [95% confidence interval (CI) = 58–84%], with non-adherence reported among 20% (95% CI = 4–37%) of migrant patients. A key finding was that there were no differences in estimated rates of adherence [risk ratio (RR) = 1.05; 95% CI = 0.82–1.34] or non-adherence (RR = 0.97; 95% CI = 0.79–1.36) between migrants and non-migrants.

Conclusions

MDR-TB treatment adherence rates among migrants in high-income low-TB-incidence countries are approaching global targets for treatment success (75%), and are comparable to rates in non-migrants. The findings highlight that only just over 70% of migrant and non-migrant patients adhere to MDR-TB treatment. The results point to the importance of increasing adherence in all patient groups, including migrants, with an emphasis on tailoring care based on social risk factors for poor adherence. We believe that MDR-TB treatment targets are not ambitious enough.
Appendix
Available only for authorised users
Literature
1.
2.
3.
Malin AS, McAdam KP. Escalating threat from tuberculosis: the third epidemic. Thorax England. 1995;50 Suppl 1:S37–42.CrossRef
4.
5.
6.
Nsofor CA, Jiang Q, Wu J, Gan M, Liu Q, Zuo T, et al. Transmission is a noticeable cause of resistance among treated tuberculosis patients in Shanghai. China Sci Rep. 2017;7:7691.CrossRefPubMed
7.
Dobler CC, Korver S, Batbayar O, Nyamdulam B, Oyuntsetseg S, Tsolmon B, et al. Multidrug-resistant tuberculosis in patients for whom first-line treatment failed, Mongolia, 2010–2011. Emerg Infect Dis. 2015;21:1451–4.CrossRefPubMedPubMedCentral
8.
9.
10.
11.
Sharma A, Hill A, Kurbatova E, van der Walt M, Kvasnovsky C, Tupasi TE, et al. Estimating the future burden of multidrug-resistant and extensively drug-resistant tuberculosis in India, the Philippines, Russia, and South Africa: a mathematical modelling study. Lancet Infect Dis. 2017;17:707–15. http://​www.​ncbi.​nlm.​nih.​gov/​pubmed/​28499828, Accessed 22 July 2017.CrossRefPubMed
12.
13.
International Organisation for Migration. Global Migration. Data Briefing. 2014;45.
14.
15.
16.
17.
18.
19.
Public Health England. TB Annual Report. 2017.
20.
21.
International Organization for Migration. Migration & tuberculosis: a pressing issue. 2012;1–4.
22.
World Health Organization Regional Office for the Western Pacific. Tuberculosis control in migrant populations: guiding principles and proposed actions. 2016. p. 24.
23.
24.
25.
26.
27.
28.
29.
30.
Laserson KF, Thorpe LE, Leimane V, Weyer K, Mitnick CD, Riekstina V, et al. Speaking the same language: treatment outcome definitions for multidrug-resistant tuberculosis. Int J Tuberc Lung Dis. 2005;9:640–5.PubMed
31.
32.
33.
34.
35.
36.
37.
38.
StataCorp. Stata statistical software: release 13. College Station, TX: StataCorp LP.
39.
40.
Sterne JA, Bradburn MJ, Egger M. Meta-analysis in StataTM. systematic reviews in health care: meta-analysis in context. 2nd ed. 2008.
41.
42.
43.
44.
45.
46.
47.
Vasankari T, Soini H, Liippo K. MDR-TB in Finland – still rare despite the situation in our neighbouring countries. Clin Respir J. 2012:35–9.
48.
Flament-Saillour M, Robert J, Jarlier V, Grosset J. Outcome of multi-drug-resistant tuberculosis in France: a nationwide case–control study. Am J Respir Crit Care Med. 1999;160:587–93.CrossRefPubMed
49.
50.
Masjedi MR, Tabarsi P, Chitsaz E, Baghaei P, Mirsaeidi M, Amiri MV, et al. Outcome of treatment of MDR-TB patients with standardised regimens, Iran, 2002–2006. Int J Tuberc Lung Dis. 2008;12:750–5.PubMed
51.
52.
Manfredi R, Nanetti A, Dal Monte P, Calza L. Increasing pathomorphism of pulmonary tuberculosis. An observational study of slow clinical, microbiological and imaging response of lung tuberculosis to specific treatment. Which role for linezolid? Brazilian J Infect Dis. 2009;13:297–303. http://​www.​scielo.​br/​pdf/​bjid/​v13n4/​v13n4a12.​pdf.
53.
54.
55.
56.
57.
Kibret KT, Moges Y, Memiah P, Biadgilign S. Treatment outcomes for multidrug-resistant tuberculosis under DOTS-Plus: a systematic review and meta-analysis of published studies. Infect Dis Poverty. 2017;6:7. http://​idpjournal.​biomedcentral.​com/​articles/​https://​doi.​org/​10.​1186/​s40249-016-0214-x, Accessed 22 July 2017.
58.
59.
60.
61.
62.
63.
Priebe S, Sandhu S, Dias S, Gaddini A, Greacen T, Ioannidis E, et al. Good practice in health care for migrants: views and experiences of care professionals in 16 European countries. BMC Public Health BioMed Central. 2011;11:187.CrossRef
64.
Woodward A, Howard N, Wolffers I. Health and access to care for undocumented migrants living in the European Union: a scoping review. Health Policy Plan. 2014;29:818–30.CrossRefPubMed
65.
Lin S, Melendez-Torres GJ. Systematic review of risk factors for nonadherence to TB treatment in immigrant populations. Trans R Soc Trop Med Hyg. 2016;110:268–80.CrossRefPubMedPubMedCentral
66.
67.
68.
69.
70.
71.
72.
73.
Public Health England. Collaborative tuberculosis strategy for England 2015 to 2020. Public Health England. 2015.
74.
75.
Dara M, de Colombani P, Petrova-Benedict R, Centis R, Zellweger JP, Sandgren A, et al. Minimum package for cross-border TB control and care in the WHO European region: a Wolfheze consensus statement. Eur Respir J. 2012;40:1081–90.CrossRefPubMedPubMedCentral
Metadata
Title
Multidrug-resistant tuberculosis treatment adherence in migrants: a systematic review and meta-analysis
Authors
Laura B. Nellums
Kieran Rustage
Sally Hargreaves
Jon S. Friedland
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2018
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-017-1001-7

Other articles of this Issue 1/2018

BMC Medicine 1/2018 Go to the issue

Research article

A longitudinal, observational study of the features of transitional healthcare associated with better outcomes for young people with long-term conditions

Research article

Simultaneously characterizing the comparative economics of routine female adolescent nonavalent human papillomavirus (HPV) vaccination and assortativity of sexual mixing in Hong Kong Chinese: a modeling analysis

Research article

Global variation in bacterial strains that cause tuberculosis disease: a systematic review and meta-analysis

Research article

Genetic variation in clusterin and risk of dementia and ischemic vascular disease in the general population: cohort studies and meta-analyses of 362,338 individuals

Opinion

Utility of circulating tumor DNA in cancer diagnostics with emphasis on early detection

Research article

The association of depression and all-cause and cause-specific mortality: an umbrella review of systematic reviews and meta-analyses