Acceptance of screening and completion of treatment for latent tuberculosis infection among refugee claimants in Canada

SETTING: Primary care clinic for refugee claimants, Montreal, Canada.

OBJECTIVES: To identify factors linked to the acceptance of the tuberculin skin test (TST), and assess completion of treatment for latent tuberculosis infection (LTBI).

DESIGN: Asylum seekers consulting for a medical complaint or medical immigration examination between February and October 1999 were assessed for eligibility. Personal and clinical information was gathered prospectively by questionnaire. Hospital files were reviewed to assess completion of LTBI treatment.

RESULTS: In our study, 296 subjects (72.4% of 409 eligible) were offered TST, of whom 227 accepted (76.7%). Of these, 49 (24.9%) had a TST ≥10 mm and 24 (49%) completed 6 months of LTBI treatment. Logistic regression models showed that patients who had never had a TST (OR 3.2, 95%CI 1.34–7.6) or had no temporary exclusion criteria (OR 4.0, 95%CI 1.6–9.9) were more likely to accept TST. Perceiving tuberculosis as a severe disease (OR 0.29, 95%CI 0.09–0.91) and consulting for an immigration examination (OR 0.42, 95%CI 0.18–0.98) was associated with refusal of TST. Increasing age was found to be independently associated with a positive TST (OR 1.06, 95%CI 1.01–1.12). Variability in the proportion of positive results was found between TST readers.

CONCLUSION: This study supports the feasibility of screening refugee claimants for LTBI during medical consultation and of developing organizational links to ensure completion of LTBI treatment.