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Volume 25, Number 4—April 2019
Research

Cost-effectiveness of Latent Tuberculosis Infection Screening before Immigration to Low-Incidence Countries

Jonathon R. Campbell, James C. Johnston, Victoria J. Cook, Mohsen Sadatsafavi, R. Kevin Elwood, and Fawziah MarraComments to Author 
Author affiliations: University of British Columbia, Vancouver, British Columbia, Canada (J.R. Campbell, J.C. Johnston, V.J. Cook, M. Sadatsafavi, R.K. Elwood, F. Marra); British Columbia Centre for Disease Control, Vancouver (J.C. Johnston, V.J. Cook, R.K. Elwood)

Main Article

Table 1

Intervention strategies for screening and treatment of latent TB infection in immigrants*

Intervention strategy Preimmigration Postarrival if test is positive
Base case
 TB screening as part of routine preimmigration medical exams, consisting of a chest radiograph, medical history, and symptom screen. If diagnosed with TB, treatment must be completed before immigrating.
 Routine follow-up of those with abnormal chest radiograph results or previous TB.
TST/INH In addition to the base case, a TST is performed at the time of the medical exam. If the result is positive (induration >10 mm) referral is made for follow-up postarrival. If the TST result is negative, no further action is taken. Recommendation for follow-up;
if patient reports for follow-up, 9-month course of INH.
TST/RIF
 Same as above.
 Recommendation for follow-up; at follow-up, 4-month course of RIF.
IGRA/INH In addition to the base case, an IGRA is placed at the time of the medical exam. If the result is positive (as defined by the manufacturer) referral is made for follow-up postarrival. If the IGRA result is negative, no further action is taken. If the IGRA result is indeterminate, a second is performed; a second consecutive indeterminate is treated as a negative. Recommendation for follow-up; if patient reports for follow-up, 9-month course of INH.
IGRA/RIF
 Same as above.
 Recommendation for follow-up; if patient reports for follow-up, 4-month course of RIF.
SEQ/INH In addition to the base case, a TST is placed at the time of the medical exam. If the result is positive (as defined by an induration >10 mm) a second test is performed with an IGRA. If the subsequent IGRA result is positive (as defined by the manufacturer) referral is made for follow-up postarrival. If the initial TST is negative or if the subsequent IGRA is negative, no further action is taken. If the IGRA result is indeterminate, a second is performed; a second consecutive indeterminate is treated as a negative. Recommendation for follow-up; at follow-up, 9-month course of INH.
SEQ/RIF Same as above. Recommendation for follow-up;
at follow-up, 4-month course of RIF.

*No intervention required for migrants with negative results of base case screening. IGRA, interferon-gamma release assay; INH, isoniazid; RIF, rifampin; SEQ, sequential screening; TB, tuberculosis TST, tuberculin skin test.

Main Article

Page created: March 17, 2019
Page updated: March 17, 2019
Page reviewed: March 17, 2019
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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