D5.1 Temporary migrant screening set up

Transcription

1 Early Detection and Integrated Management of Tuberculosis in Europe PJ Early diagnosis of tuberculosis D5.1 Temporary migrant screening set up WP 5 Migrant TB detection, prevention and treatment Due date of deliverable Month 1 27 th January 2017 Actual submission date 06 / 02/ 2017 Start date of project 3 May 2016 Duration Lead beneficiary Last editor Contributors Dissemination level 8 months OSR Daniela Maria Cirillo OSR PU This project E-DETECT TB has received funding from the European Union s Health Programme ( ) under grant agreement N o

2 Table of contents Note: Make sure to update and format the Table of contents, and to do so with each version change Table of contents... 2 Definitions and acronyms Introduction General context Methodological approach Summary of activities and research findings Screening strategies set up TB on port implementation Active case finding in CARA centre Active TB screening tools Questionnaire and sputum collection Ethics committee EDETECT APP Conclusions and future steps... 6 PU Page 2 of 6 Version 01

3 Definitions and acronyms Acronyms TB LTBI CARA CSPA Usmaf Definitions Tuberculosis Latent tuberculosis Infection Centri di accoglienza per richiedenti asilo, center for asylum seekers Centri di primo soccorso e accoglienza Uffici di sanità marittima, aérea e di frontiera PU Page 3 of 6 Version 01

4 1. Introduction Interventions targeting the immediate health and social need of migrants are needed both to guarantee the individual human rights (independent of the residential status of the patient) and to progress toward the goal of TB elimination. The scope of work-package 5 (WP5)- Migrant TB detection, prevention and treatment, is to establish a mechanism to ensure that health services delivering TB care are accessible to refugees at the point of arrival and to identify the asylum seekers as a relatively stable population who offer the opportunity of screening and treatment interventions for both active TB and LTBI. The aim of deliverable 5.1-Temporary migrant screening set up was to develop in collaboration with local and national health and immigration authorities a coordinated protocol of intervention in a selected sample of CSPA centre General context The unpredictable arrival on migrants at several ports of Sicily and other South of Italy shores represent a major challenge. Although a protocol for screening refugees exists, the implementation is difficult, highly demanding and resource intensive. Local health authorities (Usmaf) in collaboration with Garibaldi Hospital in Catania are carrying out the active TB screening at Catania harbour, while at present an active case finding strategies for TB disease is not provided by local health service in CSPA and CARA due to the limited resource. Case finding is so limited to symptomatic individuals self-reporting to local health authorities. 2. Methodological approach Two main lines of action have been identified after analysis of the data from the Prefettura di Catania summarizing the arrival in the last year and after discussion with public authorities and local health authorities. 1) Implementing the Usmaf initiative TB on port by giving an on-spot tool for active TB diagnosis: expert OMNI (Cepheid). Rationale: empowering the real-time active TB detection at point of arrival. This will allow to avoid transport of this population to local hospital for testing which requires government directed police escort and support. OSR will provide the expert OMNI, once available; Ultra cartridges for sputum analysis; local staff training on the Ultra, Ultra and OMNI expert laboratory procedures. 2) Setting up an active case finding strategy in a selected CARA centre in Sicily. Targeting the action on CSPA and CARA in Sicily will allow to perform an accurate screening on a population coming from different harbours including the ones in which the screening at the point of arrival is still not performed. 3. Summary of activities and research findings 3.1. Screening strategies set up We identify two main lines of action: 1) implementing the Usmaf initiative TB on port, 2) setting up an active case finding strategies in a selected CARA centre in Sicily PU Page 4 of 6 Version 01

5 3.1.1 TB on port implementation We established links with the Ministry of Health of Italy and with local authorities. We agreed to contribute to the initiative TB on port that is carried out at Catania harbour by Sicily local government in collaboration with the Italian MoH to screen for TB arriving immigrants directly at the quayside. Screening time would be extended from 1 year to 1.5 years to allow for at least 10 months of using the Xpert OMNI platform which will be available next September Active case finding in CARA centre Active TB screening strategies at CARA and CSPA as be widely discussed between WP5 partners and local health authorities. All people arriving at the centres will be offered the opportunity to participate in this voluntary screening by completing a questionnaire provided in different languages (with the support of an interpreter if deemed necessary). Based on the score obtained in the questionnaire, those with suspected pulmonary TB will be identified, sputum will be collected on site and tested by GeneXpert; Individuals identified as MTB positive will be promptly transferred for treatment initiation and further testing. The intervention will take place in the Centre of Mineo under the Prefettura of Catania in collaboration with local Authorities and local health service currently provide by Red Cross. The CARA in Mineo is the biggest residence for asylum seekers in Europe. It hosts approximately 4000 refugees including just arrived asylum seekers and refused asylum seekers waiting for judicial review. The estimated arrivals rate is of 200 persons-month Active TB screening tools Questionnaire and sputum collection Screening will be carried out by trained medical staff through a questionnaire. The questionnaire (appendix A) include personal data, date of arrival in the centre, past medical history, past TB history, risk factors for TB including HIV. Symptoms suggestive of TB defined as any cough, fever, haemoptysis, night sweats and weight loss will be also collected. Questionnaires available in three different languages and the support of an interpreter will be available when demanded. WP5 partners agreed that sputum sample will be collected when at least one of the symptoms is present. This strategy will also allow the evaluation of each symptoms sensitivity and specificity for active TB disease in migrant population. Ultra cartridges RO (research only) will be made available for the study in addition to G4, until commercially available Ethics committee The study entitle EARLY DETECTION AND INTEGRATED MANAGEMENT OF TUBERCULOSISIN EUROPE: E- DETECT TB (WP5 Migrant TB detection, prevention and treatment) presented at San Raffaele Institute Ethic Commission (protocol number ) the 25th October 2016 was approved the 10th November Informed written consent will be obtained from each subject before data collection EDETECT APP As a part of D5.8- Development of an effective, digital recording tool for CPSA and CARA residents, we plan to substitute the questionnaire with a digital recording tool. The use of a digital tool to preform active TB screening will allow the standardization of the TB screening practice and the possibility to record and share all the patient s information in a common database which will ideally be shared by all CARA and CSPA centres. APP contents have been widely discussed among WP5 partners. The design of the APP has been subcontracted. Selection of the subcontractor has been performed. A preliminary App containing all the information needed for active TB screening has been already designed. After revision by all the WP5 partners it was found that this preliminary APP will greatly benefit from the PU Page 5 of 6 Version 01

6 adding of a second track for LTBI screening. The APP for active TB screening is ready to be finalized and used in the next month. 4. Conclusions and future steps Set up of active TB screening in temporary migrant population is fully achieved on time (deadline postponed to M8). We could start the active TB screening at CARA of Mine by the end of November We have at present already screened around 1300 subjects. PU Page 6 of 6 Version 01