MDR-TB treatment adherence in migrants: a systematic review and meta-analysis
File(s)
Published version
Author(s)
Nellums, LB
Rustage, Kieran
Hargreaves, Sally
Friedland, Jon
Type
Journal Article
Abstract
Background: 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. 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% CI:
58-84%), with non-adherence reported among 20% (95% CI:
4-37%) of migrant patients. A key finding was there were no
Differences in estimated rates of adherence (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.
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. 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% CI:
58-84%), with non-adherence reported among 20% (95% CI:
4-37%) of migrant patients. A key finding was there were no
Differences in estimated rates of adherence (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.
Date Issued
2018-02-22
Date Acceptance
2017-12-21
Citation
BMC Medicine
ISSN
1741-7015
Publisher
BioMed Central
Journal / Book Title
BMC Medicine
Volume
16
Copyright Statement
© The Author(s). 2018.
This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Subjects
11 Medical And Health Sciences
General & Internal Medicine
Publication Status
Accepted
Article Number
ARTN 27