1650. Enhanced Tuberculosis (TB) Screening Program for Refugees in Edmonton, Canada: High-Completion Rates Facilitated by Prompt Referral and Assessment Upon Arrival
Session: Poster Abstract Session: Mycobacterial Infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C

Background:

Over half of new Tuberculosis (TB) cases in North America each year occur in foreign-born individuals. Refugee populations are considered at particularly high risk in the first few years after immigration. In Edmonton, all government-sponsored refugees receive prompt medical evaluation at the New Canadians' Clinic within a few weeks of arrival to Canada.

Methods:

We retrospectively reviewed consecutive patients at the Edmonton New Canadians' Clinic TB screening program evaluated between 2009 and 2011. We sought insight into completeness of initial assessment, diagnosis of latent infection, and adherence to TB prophylaxis.

Results:

During the three-year interval, 949 refugees were evaluated. All (100%) received an initial assessment by a TB nurse with subsequent chest x-ray (CXR) and tuberculin skin test (TST) if required. 746 TSTs were successfully planted and read, of these, 265 (36%) were positive. Confirmation with Interferon-Gamma Release Assay (IGRA) testing was performed in 203 TST positive individuals without other TB disease risk factors. Of the IGRAs performed, 54% were positive, suggesting a high "false-positive" TST rate, even amongst these highly selected patients. Sub-Saharan Africans were more likely to have IGRA confirmation than refugees from other regions (75/105 (71%) versus 35/93 (38%) p < 0.005).  

Of the 949 refugees, self-administered TB prophylaxis was offered to 147. Initial acceptance rate was very high with 141 (96%) taking at least one dose of prophylaxis and103 (73%) completing an entire course of TB prophylaxis. Statistically significant correlates of non-adherence to therapy include young age (p=0.039) and Sub-Saharan African origin (p<0.005). Only 64% of Sub-Saharan African refugees completed TB prophylaxis.  

Conclusion:

In summary, we observed a very high degree of patient retention with initial TB clinic visits and for completion of TB investigations. Latent TB treatment completion rates were high compared to published results from other programs. This care model promises to be a component of effective TB prevention in refugee populations.

Elissa Rennert-May, MD1, Elisabeth Hansen, RN2, Stan Houston, MD1,3, Toktam Zadeh, BScN2 and Ryan Cooper, MD, MPH1,2,3, (1)Infectious Diseases, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada, (2)Edmonton Tuberculosis Clinic, Edmonton, AB, Canada, (3)University of Alberta School of Public Health, Edmonton, AB, Canada

Disclosures:

E. Rennert-May, None

E. Hansen, None

S. Houston, None

R. Cooper, None

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