International TB Standards & Strategies for Screening in Migrants. IOM Perspectives

Transcription

1 International TB Standards & Strategies for Screening in Migrants IOM Perspectives

2 TB Screening for Migration A duality?...don t splash all over the mainstream media that immigrants have TB, it will just make the discrimination that might exist, even higher. Abarca Tomás B, at al. A Systematic Review of the Qualitative Literature. PLoS ONE 8(12): e "..fear of deportation discourages patients with symptoms of the disease from coming forward, thus allowing the infection to spread"

3 Systematic Active TB Screening, WHO Risk groups: Immigrants from settings with high prevalence of TB People in refugee camps. Principles: 1. Ensure high-quality TB diagnosis, treatment, care, support. 2. Avoid indiscriminate mass screening, prioritize risk groups. 3. Assess accuracy, availability, feasibility, costs for algorithms. 4. Follow established ethical principles, human rights, minimize discrimination. 5. Optimize synergies with health and social service delivery. 6. Continually monitor and reassess screening strategy.

4 Content I. Global Migration Context II. Migration in the Global TB plans, and role of TB Screening. III. IOM Experiences in Migration Health Assessments V. Conclusion

5 International migration is set to grow even faster than in the past quartercentury (Intelligence Council on Global Trends 2030, December 2012 issue) Global Migration Context 7.4 billion population >1 billion migrants 250 million international 760 million internal Urbanization: >50% Feminization: 50% Under 20 years of age: 33M 60m forced displacements Comprised of: 38m displaced due to conflict and violence (2014, IDMC) 22m displaced due to natural disasters (2013, IDMC)

6 208.8 m Labor Migrants & Families 4 m Students 19.5m Refugees 250 Million International Migrants m Other 250 m Recorded Migrants 55 m Irregular Migrants (est.) Sources: UNDESA, 2013; UNHCR, 2014; ILO, 2014; UNESCO, 2013; UNDP, Figures are latest available stock estimates for either 2013, 2012 or 2010 totals for each group at the end of the most recent year for which figures have been produced 6

7 Migration: a Social Determinant of Health Spaces of Vulnerability There are risks involved with TB infection at ALL POINTS of the migration process.

8 Global Migration & TB Burden Key countries of origin for migration are also high TBburden countries; India, Russian Federation, Bangladesh, China, Pakistan, Philippines, Afghanistan, Indonesia. (also high rates of internal migration) In several low TB burden (and migrant-receiving countries), TB is often observed in foreignborn persons, either prevalent infection, or reactivation of latent TB.

9 Global Migration & Public Health WHA Resolution Health of Migrants, 2008 Setting the global framework.

10 Migration in the SDGs 3.8: UNIVERSAL HEALTH COVERAGE, AND ACCESS TO QUALITY HEALTH-CARE SERVICES LEAVE NO ONE BEHIND!

11 Migration in the Global TB Plans

12 Integrated patient-centered care and prevention Bold policies and supportive systems Intensified research and innovation Guided by resolution WHA61.17 on the health of migrants and its appeal for action, and recognizing the need for increased collaboration between high- and low-incidence countries and regions in strengthening tuberculosis monitoring and control mechanisms, including with regard to the growing mobility of labour; including migrant populations

13 MIGRANT-INCLUSIVE NATIONAL TB PLANS ABCDE MIGRANT-SENSITIVE CARE & PREVENTION Migration in the Gobal TB Plans: IOM-WHO efforts for adaptation BOLD INTERSECTORAL POLICIES & SYSTEMS OPERATIONAL RESEARCH AND INNOVATION

14 Pillar One: Migrant-sensitive TB care and prevention Ensure that TB diagnostics, treatment and care services are adapted to the needs of migrants, including for MDR- TB, TB/HIV management. Establish cross-border referral systems with contact tracing and information sharing to ensure continuity of care for migrants and harmonize treatment protocols across borders along migration corridors.

15 Pillar Two: Bold intersectoral policies & systems Ensure policy coherence between health and non-health sectors, such as immigration and labour, to support migrant TB interventions within and across countries. Pillar Three: Operational Research Evaluation studies to inform active case finding and treatment mechanisms.

16 TB Screening role in reaching End TB Targets?

17 Screening Pathway to Increase TB Detection

18 Active TB Screening Beyond IMEs & Resettlement I. TB

19 Active TB Screening Beyond IMEs & Resettlement I. TB

20 Migration Health Assessments, 2015 MENA 41,917 Africa 94,529 Refugees: 35,978 (85.8%) Immigrants: 5,939 (14.2%) Refugees: 42,618 (45.1%) Immigrants: 51,911 (54.9%) EU and CA 43,427 Asia 154,906 Refugees: Refugees: 3,940 (9.1 %) Immigrants: 39,487 (90.9 %) 32,126 (20.7%) Immigrants: 122,780 (79.3%) Programmes Resettlement and Immigration to USA, UK, Canada, Australia, New Zealand, EU and other countries Assisted Population 334,779 refugees and immigrants (34% refugees) worldwide, 2015 Locations 82 countries worldwide From 2008 to 2015, IOM performed over 2.4 million health assessments

21 IOM Experiences in Migration Health Assessments (MHAs) TB Screening Accountable to : Migrants Member States Global Health Community and the Organization as a whole

22 Relevant Public Health Sectors in Migration Health Assessments

23 Screening services adapted to migrants needs.- camp or urban settings, remote areas access. Culturally competent services language barriers, understanding of local epidemiology TB Screening Migrant-sensitive services

24 MHAs TB Diagnostics, Treatment Age and Sex adjusted prevalence of bacteriological and culture confirmed TB diagnosed at pre-entry screening /UK) compared to 2010 WHO country prevalence estimates ( ). (Aldridge et al. Forthcoming) Year Started Rx Active TB Started Treatment No. No. % Critical Link with potential for strengthening Active TB detection followed by treatment referrals and integration with NTP efforts

25 MHAs TB Screening Access to new technologies

26 Operational Research Needs Remote DOT, Digital Radiology Active TB Contact tracing, Notification. Latent TB screening (IGRA?), management / follow-up. Identify socioeconomic factors in migrant TB disease burden. Strengthen migrant education programmes. Evidence-based enhancement in Quality, Integrity, Ethical Standards.

27 Building local capacity in TB diagnostics and treatment Critical Link with potential for strengthening Active TB screening programmes build health systems capacity in countries of origin/transit. Hands-on training on sputum culture at IOM s Islamabad laboratory, courtesy of IOM laboratory technician Mr. Aziz. IOM

28 Bold Intersectoral Policies on TB Screening & MHAs Improve migrants access to services, with financial and social protection. Eliminate legal and administrative barriers, including non-evidence based and unethical practices on mobility restrictions and deportations.. Gulf Countries Council Approved Medical Centers Association Operating in 15 countries

29 Conclusion TB Screening can be an effective public health instrument Any international guidance or standards should respect the need for screening to be: non-discriminatory, non-stigmatizing linked to access to treatment, care and support. responsive to appropriate risk assessments and effectiveness evaluated. ultimately to serve the true needs of refugees and other migrants.

30 Lessons Learned Global Platforms

31 Discussion