DOI: 10.5061/dryad.n8pk0p2wm
title: Incidence of TB by country of origin - Estrie region

description: The identification and treatment of latent tuberculosis infection (LTBI)
 among immigrants from high-incidence regions who move to low-incidence
 countries is generally considered an ineffective strategy because only
 ≈14% of them comply with the multiple steps of the ‘cascade of care’ and
 complete treatment. In the Estrie region of Canada, a refugee clinic was
 opened in 2009. One of its goals is LTBI management. Between 2009-2020,
 5131 refugees were evaluated. To determine the efficacy and benefit-cost
 ratio of this intervention, records of refugees seen in 2010-14 (n=1906)
 and 2018-19 (n=1638) were reviewed. Cases of tuberculosis (TB) among our
 foreign-born population occurring before (1997-2008) and after (2009-2020)
 setting up the clinic were identified. All costs associated with TB or
 LTBI were measured. Out of 441 patients offered LTBI treatment, 374 (85%)
 were compliant. Adding other losses, overall compliance was 69%. To
 prevent one case of TB, 95.1 individuals had to be screened and 11.9
 treated, at a cost of $16,056. After discounting, each case of TB averted
 represented $32,631, for a benefit-cost ratio of 2.03. Among nationals of
 the 20 countries where refugees came from, incidence of TB decreased from
 68.2 (1997-2008) to 26.3 per 100,000 person-years (2009-2020). Incidence
 among persons from high-incidence countries not targeted by the
 intervention did not change (12.4 vs 12.8 per 100,000) Among refugees
 settling in our region, 69% completed the LTBI cascade of care, leading to
 a 61% reduction in TB incidence. This intervention was cost-beneficial.
 Key factors for this satisfactory compliance included: close collaboration
 with community organizations, its integration within a comprehensive
 package of medical care for the whole family, its delivery shortly after
 arrival, shorter rifampicin-based treatment, and risk-based selection of
 patients to be treated. Management of LTBI among migrants should not be
 considered a lost cause.
description: Statistics Canada provided data concerning the country of birth
 of all individuals living in Estrie region from censuses or surveys
 performed in 1996, 2001, 2006, 2011 and 2016. Foreign-born individuals
 include immigrants, non-permanent residents (students, qualified workers)
 and respondents born abroad of Canadian parents. Intercensal estimates
 were calculated according to the rate of change between censuses for
 specific subpopulations. Immigration Canada provided data on the number
 and categories of immigrants, for each country, who settled in Estrie from
 2009 to 2020. Cases of TB were idenfied through our hospital records and
 defined defined as patients having Mycobacterium tuberculosis detected by
 culture and/or polymerase chain reaction. The annual incidence of
 tuberculosis in the immigrants' home countries for each of the last
 20 years was obtained from the World Bank.
description: A first sheet shows the data from all countries of origins,
 excepted the USA and Western Europe. Other sheets show the data for the 20
 countries where our refugees came from, for all countries excepted those
 of refugees, and from all countries where incidence of TB is at least 50
 per 100000 excepted those of refugees.