Outcome of Tuberculosis Treatment in Non-citizen Migrants; Comparison Between Israel and Selected Western Countries, 2000 - 2014

Background: Migrants account for approximately 50% of Tuberculosis (TB) cases in low TB incidence countries. Despite that WHO recommends gratuitous treatment for all TB cases, information on policy regarding TB treatment of undocumented migrants (UM) in low-incidence countries are not readily available.

Objectives: To assess access to TB care and outcome of treatment for UM in 5 low TB-incidence countries were examined in order to analyse their management.

Methods: We chose 4 Western countries considered at TB pre-elimination phase, with a significant proportion of foreign-born TB cases as notified in 2012 (Israel-90%; Australia-87%; The Netherlands-73% and the USA-63%), and the United Kingdom (UK- 73%). TB outcome of treatment among migrants diagnosed in Israel for the years 2000-2014 was analysed. We searched PUBMED, MEDLINE (from 01/2000-08/2017) for relevant articles on TB control policy among non-citizen migrants and TB outcome of treatment for these selected countries.

Results: We identified 18 publications that met the inclusion criteria. While all selected countries offered access to TB care, Israel was found to be the only country which offers completely gratuitous TB healthcare to UM. Israel reported the lowest TB-incidence rate (11.4/100,000) while the UK reported the highest TB-incidence rate (51.2/100,000) among migrants for 2015. Successful outcome of TB treatment of non-citizen migrants in Israel was 87%, The Netherlands was 90.7%, The UK was 82.1%, and outcome measurements for the US and Australia were not published. Being HIV+ (OR-3.025; CI: 1.582-5.786) and being from the Horn of Africa (OR-4.006; CI: 1.810-8.870) were risk factors affecting the treatment success among non-citizen migrants in Israel.

Conclusion: Free access to TB care for undocumented migrants should be an important component for TB Elimination in several Western countries. Despite logistic difficulties, we suggest an analysis of the outcome of TB treatment also among undocumented migrants.