Community health workers improve contact tracing among immigrants with tuberculosis in Barcelona
The important increase in immigration during recent years has changed the epidemiology and control strategies for tuberculosis (TB) in many places. This study evaluates the effectiveness of intervention with community health workers (CHW) to improve contact tracing among immigrants. The study includ...
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| Published in | BMC public health Vol. 12; no. 1; p. 158 |
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| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English |
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England
BioMed Central Ltd
06.03.2012
BioMed Central BMC |
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| Abstract | The important increase in immigration during recent years has changed the epidemiology and control strategies for tuberculosis (TB) in many places. This study evaluates the effectiveness of intervention with community health workers (CHW) to improve contact tracing among immigrants.
The study included all TB cases detected by the Barcelona TB Program from 2000 to 2005 and compared a period without CHW intervention (2000-2002) to a period with CHW intervention (2003-2005). The influence on contact tracing of sex, age, hospital of diagnosis, district of residence, birthplace, HIV, homeless and CHW intervention was analysed by logistic regression. Odds ratio (OR) and 95% confidence intervals (CI) were calculated.
960 foreign born TB cases were detected, 388 in the intervention period. Contact tracing was performed on 65,7% of 201 smear-positive cases during the pre-intervention period compared to 81.6% of 152 smear-positive TB cases during the intervention period (p < 0.001). Risk factors associated with incomplete contact tracing of smear-positive index cases included being diagnosed in two hospitals without contact tracing TB unit (OR = 3.5; CI:1.4-8.9) and (OR = 4.6; CI:1.6-13.5) respectively, birth place in India-Pakistan (OR = 4.4; CI:1.9-10.3) or North Africa (OR = 4.3; CI:1.8-10.5), having an unknown residence (OR = 5.4; CI:1.6-18.0), being HIV-infected (OR = 6.1; CI:2.5-14.8) or homeless (OR = 3.3; CI:1.3-8.2), and the absence of CHW intervention (OR = 2.4; CI:1.3-4.3).
The effectiveness of contact tracing for TB control in areas with high immigration can be improved by incorporating CHWs who act as translators, cultural mediators and facilitators who accompany cases and contacts through treatment and follow-up. |
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| AbstractList | Abstract Background The important increase in immigration during recent years has changed the epidemiology and control strategies for tuberculosis (TB) in many places. This study evaluates the effectiveness of intervention with community health workers (CHW) to improve contact tracing among immigrants. Methods The study included all TB cases detected by the Barcelona TB Program from 2000 to 2005 and compared a period without CHW intervention (2000-2002) to a period with CHW intervention (2003-2005). The influence on contact tracing of sex, age, hospital of diagnosis, district of residence, birthplace, HIV, homeless and CHW intervention was analysed by logistic regression. Odds ratio (OR) and 95% confidence intervals (CI) were calculated. Results 960 foreign born TB cases were detected, 388 in the intervention period. Contact tracing was performed on 65,7% of 201 smear-positive cases during the pre-intervention period compared to 81.6% of 152 smear-positive TB cases during the intervention period (p < 0.001). Risk factors associated with incomplete contact tracing of smear-positive index cases included being diagnosed in two hospitals without contact tracing TB unit (OR = 3.5; CI:1.4-8.9) and (OR = 4.6; CI:1.6-13.5) respectively, birth place in India-Pakistan (OR = 4.4; CI:1.9-10.3) or North Africa (OR = 4.3; CI:1.8-10.5), having an unknown residence (OR = 5.4; CI:1.6-18.0), being HIV-infected (OR = 6.1; CI:2.5-14.8) or homeless (OR = 3.3; CI:1.3-8.2), and the absence of CHW intervention (OR = 2.4; CI:1.3-4.3). Conclusions The effectiveness of contact tracing for TB control in areas with high immigration can be improved by incorporating CHWs who act as translators, cultural mediators and facilitators who accompany cases and contacts through treatment and follow-up. BACKGROUNDThe important increase in immigration during recent years has changed the epidemiology and control strategies for tuberculosis (TB) in many places. This study evaluates the effectiveness of intervention with community health workers (CHW) to improve contact tracing among immigrants.METHODSThe study included all TB cases detected by the Barcelona TB Program from 2000 to 2005 and compared a period without CHW intervention (2000-2002) to a period with CHW intervention (2003-2005). The influence on contact tracing of sex, age, hospital of diagnosis, district of residence, birthplace, HIV, homeless and CHW intervention was analysed by logistic regression. Odds ratio (OR) and 95% confidence intervals (CI) were calculated.RESULTS960 foreign born TB cases were detected, 388 in the intervention period. Contact tracing was performed on 65,7% of 201 smear-positive cases during the pre-intervention period compared to 81.6% of 152 smear-positive TB cases during the intervention period (p < 0.001). Risk factors associated with incomplete contact tracing of smear-positive index cases included being diagnosed in two hospitals without contact tracing TB unit (OR = 3.5; CI:1.4-8.9) and (OR = 4.6; CI:1.6-13.5) respectively, birth place in India-Pakistan (OR = 4.4; CI:1.9-10.3) or North Africa (OR = 4.3; CI:1.8-10.5), having an unknown residence (OR = 5.4; CI:1.6-18.0), being HIV-infected (OR = 6.1; CI:2.5-14.8) or homeless (OR = 3.3; CI:1.3-8.2), and the absence of CHW intervention (OR = 2.4; CI:1.3-4.3).CONCLUSIONSThe effectiveness of contact tracing for TB control in areas with high immigration can be improved by incorporating CHWs who act as translators, cultural mediators and facilitators who accompany cases and contacts through treatment and follow-up. Background: The important increase in immigration during recent years has changed the epidemiology and control strategies for tuberculosis (TB) in many places. This study evaluates the effectiveness of intervention with community health workers (CHW) to improve contact tracing among immigrants. Methods: The study included all TB cases detected by the Barcelona TB Program from 2000 to 2005 and compared a period without CHW intervention (2000-2002) to a period with CHW intervention (2003-2005). The influence on contact tracing of sex, age, hospital of diagnosis, district of residence, birthplace, HIV, homeless and CHW intervention was analysed by logistic regression. Odds ratio (OR) and 95% confidence intervals (CI) were calculated. Results: 960 foreign born TB cases were detected, 388 in the intervention period. Contact tracing was performed on 65,7% of 201 smear-positive cases during the pre-intervention period compared to 81.6% of 152 smear-positive TB cases during the intervention period (p < 0.001). Risk factors associated with incomplete contact tracing of smear-positive index cases included being diagnosed in two hospitals without contact tracing TB unit (OR = 3.5; CI:1.4-8.9) and (OR = 4.6; CI:1.6-13.5) respectively, birth place in India-Pakistan (OR = 4.4; CI:1.9-10.3) or North Africa (OR = 4.3; CI:1.8-10.5), having an unknown residence (OR = 5.4; CI:1.6-18.0), being HIV-infected (OR = 6.1; CI:2.5-14.8) or homeless (OR = 3.3; CI:1.3-8.2), and the absence of CHW intervention (OR = 2.4; CI:1.3-4.3). Conclusions: The effectiveness of contact tracing for TB control in areas with high immigration can be improved by incorporating CHWs who act as translators, cultural mediators and facilitators who accompany cases and contacts through treatment and follow-up. Background The important increase in immigration during recent years has changed the epidemiology and control strategies for tuberculosis (TB) in many places. This study evaluates the effectiveness of intervention with community health workers (CHW) to improve contact tracing among immigrants. Methods The study included all TB cases detected by the Barcelona TB Program from 2000 to 2005 and compared a period without CHW intervention (2000-2002) to a period with CHW intervention (2003-2005). The influence on contact tracing of sex, age, hospital of diagnosis, district of residence, birthplace, HIV, homeless and CHW intervention was analysed by logistic regression. Odds ratio (OR) and 95% confidence intervals (CI) were calculated. Results 960 foreign born TB cases were detected, 388 in the intervention period. Contact tracing was performed on 65,7% of 201 smear-positive cases during the pre-intervention period compared to 81.6% of 152 smear-positive TB cases during the intervention period (p [less than] 0.001). Risk factors associated with incomplete contact tracing of smear-positive index cases included being diagnosed in two hospitals without contact tracing TB unit (OR = 3.5; CI:1.4-8.9) and (OR = 4.6; CI:1.6-13.5) respectively, birth place in India-Pakistan (OR = 4.4; CI:1.9-10.3) or North Africa (OR = 4.3; CI:1.8-10.5), having an unknown residence (OR = 5.4; CI:1.6-18.0), being HIV-infected (OR = 6.1; CI:2.5-14.8) or homeless (OR = 3.3; CI:1.3-8.2), and the absence of CHW intervention (OR = 2.4; CI:1.3-4.3). Conclusions The effectiveness of contact tracing for TB control in areas with high immigration can be improved by incorporating CHWs who act as translators, cultural mediators and facilitators who accompany cases and contacts through treatment and follow-up. The important increase in immigration during recent years has changed the epidemiology and control strategies for tuberculosis (TB) in many places. This study evaluates the effectiveness of intervention with community health workers (CHW) to improve contact tracing among immigrants. The study included all TB cases detected by the Barcelona TB Program from 2000 to 2005 and compared a period without CHW intervention (2000-2002) to a period with CHW intervention (2003-2005). The influence on contact tracing of sex, age, hospital of diagnosis, district of residence, birthplace, HIV, homeless and CHW intervention was analysed by logistic regression. Odds ratio (OR) and 95% confidence intervals (CI) were calculated. 960 foreign born TB cases were detected, 388 in the intervention period. Contact tracing was performed on 65,7% of 201 smear-positive cases during the pre-intervention period compared to 81.6% of 152 smear-positive TB cases during the intervention period (p [less than] 0.001). Risk factors associated with incomplete contact tracing of smear-positive index cases included being diagnosed in two hospitals without contact tracing TB unit (OR = 3.5; CI:1.4-8.9) and (OR = 4.6; CI:1.6-13.5) respectively, birth place in India-Pakistan (OR = 4.4; CI:1.9-10.3) or North Africa (OR = 4.3; CI:1.8-10.5), having an unknown residence (OR = 5.4; CI:1.6-18.0), being HIV-infected (OR = 6.1; CI:2.5-14.8) or homeless (OR = 3.3; CI:1.3-8.2), and the absence of CHW intervention (OR = 2.4; CI:1.3-4.3). The effectiveness of contact tracing for TB control in areas with high immigration can be improved by incorporating CHWs who act as translators, cultural mediators and facilitators who accompany cases and contacts through treatment and follow-up. Doc number: 158 Abstract Background: The important increase in immigration during recent years has changed the epidemiology and control strategies for tuberculosis (TB) in many places. This study evaluates the effectiveness of intervention with community health workers (CHW) to improve contact tracing among immigrants. Methods: The study included all TB cases detected by the Barcelona TB Program from 2000 to 2005 and compared a period without CHW intervention (2000-2002) to a period with CHW intervention (2003-2005). The influence on contact tracing of sex, age, hospital of diagnosis, district of residence, birthplace, HIV, homeless and CHW intervention was analysed by logistic regression. Odds ratio (OR) and 95% confidence intervals (CI) were calculated. Results: 960 foreign born TB cases were detected, 388 in the intervention period. Contact tracing was performed on 65,7% of 201 smear-positive cases during the pre-intervention period compared to 81.6% of 152 smear-positive TB cases during the intervention period (p < 0.001). Risk factors associated with incomplete contact tracing of smear-positive index cases included being diagnosed in two hospitals without contact tracing TB unit (OR = 3.5; CI:1.4-8.9) and (OR = 4.6; CI:1.6-13.5) respectively, birth place in India-Pakistan (OR = 4.4; CI:1.9-10.3) or North Africa (OR = 4.3; CI:1.8-10.5), having an unknown residence (OR = 5.4; CI:1.6-18.0), being HIV-infected (OR = 6.1; CI:2.5-14.8) or homeless (OR = 3.3; CI:1.3-8.2), and the absence of CHW intervention (OR = 2.4; CI:1.3-4.3). Conclusions: The effectiveness of contact tracing for TB control in areas with high immigration can be improved by incorporating CHWs who act as translators, cultural mediators and facilitators who accompany cases and contacts through treatment and follow-up. The important increase in immigration during recent years has changed the epidemiology and control strategies for tuberculosis (TB) in many places. This study evaluates the effectiveness of intervention with community health workers (CHW) to improve contact tracing among immigrants. The study included all TB cases detected by the Barcelona TB Program from 2000 to 2005 and compared a period without CHW intervention (2000-2002) to a period with CHW intervention (2003-2005). The influence on contact tracing of sex, age, hospital of diagnosis, district of residence, birthplace, HIV, homeless and CHW intervention was analysed by logistic regression. Odds ratio (OR) and 95% confidence intervals (CI) were calculated. 960 foreign born TB cases were detected, 388 in the intervention period. Contact tracing was performed on 65,7% of 201 smear-positive cases during the pre-intervention period compared to 81.6% of 152 smear-positive TB cases during the intervention period (p < 0.001). Risk factors associated with incomplete contact tracing of smear-positive index cases included being diagnosed in two hospitals without contact tracing TB unit (OR = 3.5; CI:1.4-8.9) and (OR = 4.6; CI:1.6-13.5) respectively, birth place in India-Pakistan (OR = 4.4; CI:1.9-10.3) or North Africa (OR = 4.3; CI:1.8-10.5), having an unknown residence (OR = 5.4; CI:1.6-18.0), being HIV-infected (OR = 6.1; CI:2.5-14.8) or homeless (OR = 3.3; CI:1.3-8.2), and the absence of CHW intervention (OR = 2.4; CI:1.3-4.3). The effectiveness of contact tracing for TB control in areas with high immigration can be improved by incorporating CHWs who act as translators, cultural mediators and facilitators who accompany cases and contacts through treatment and follow-up. |
| ArticleNumber | 158 |
| Audience | Academic |
| Author | Orcau, Angels Casals, Martí Sánchez, Francesca Ospina, Jesús Edison Millet, Juan-Pablo Caylà, Joan A |
| AuthorAffiliation | 4 Servicios de Medicina Interna, Enfermedades Infecciosas y Microbiología del Hospital del Mar Barcelona, Paseo Marítimo 25-29, 08003 Barcelona, Spain 3 CIBER Epidemiología y Salud Pública (CIBERESP), C/Melchor Fernández Almagro 3-5, 28029, Madrid, Spain 6 Departament de Ciencies Basiques, Universitat Internacional de Catalunya, Josep Trueta s/n 08195 Sant Cugat del Vallés, Spain 1 Epidemiology Service, Public Health Agency of Barcelona, Plaza Lesseps 1, 08023 Barcelona, Spain 5 Departament de Salut Pública, Universitat de Barcelona, Gran Via de les Corts Catalanes, 585, 08007 Barcelona, Spain 2 Departament de Pediatria, Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona (UAB), Plaza Cívica-Campus de la UAB 08193 Bellaterra, Spain |
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| Author_xml | – sequence: 1 givenname: Jesús Edison surname: Ospina fullname: Ospina, Jesús Edison email: jospina@aspb.es organization: Epidemiology Service, Public Health Agency of Barcelona, Plaza Lesseps 1, 08023 Barcelona, Spain. jospina@aspb.es – sequence: 2 givenname: Angels surname: Orcau fullname: Orcau, Angels – sequence: 3 givenname: Juan-Pablo surname: Millet fullname: Millet, Juan-Pablo – sequence: 4 givenname: Francesca surname: Sánchez fullname: Sánchez, Francesca – sequence: 5 givenname: Martí surname: Casals fullname: Casals, Martí – sequence: 6 givenname: Joan A surname: Caylà fullname: Caylà, Joan A |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/22394990$$D View this record in MEDLINE/PubMed |
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| Copyright | COPYRIGHT 2012 BioMed Central Ltd. 2012 Ospina et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright ©2012 Ospina et al; licensee BioMed Central Ltd. 2012 Ospina et al; licensee BioMed Central Ltd. |
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| References | 3894_CR17 Centers for Disease Control and Prevention (3894_CR21) 1998; 47 JE Ospina (3894_CR14) 2004 MA Islam (3894_CR32) 2002; 80 3894_CR13 J Dick (3894_CR31) 1996 3894_CR15 T Rodrigo (3894_CR24) 2001; 5 HL Rieder (3894_CR23) 1994; 8 UNESCO (3894_CR27) 2003 3894_CR4 3894_CR5 3894_CR2 3894_CR3 3894_CR1 RJ Asghar (3894_CR20) 2009; 86 3894_CR8 Centers for Diseases control an Prevention (3894_CR9) 2005; 54 3894_CR6 3894_CR7 3894_CR26 UITB (3894_CR12) 1999; 112 AM Marques (3894_CR22) 2003; 19 UNAIDS (3894_CR18) 1999 JL Cañada (3894_CR25) 2002 Health Institut Carlos III (3894_CR11) 2003 UNAIDS (3894_CR30) 2001 JD Porter (3894_CR29) 2002; 73 Core group (3894_CR28) 2004 R Development Core Team (3894_CR16) 2007 UITB, SEPAR, GESIDA, SEIMC,SESP (3894_CR10) 2003; 121 Lw Yun (3894_CR19) 2003; 7 |
| References_xml | – ident: 3894_CR6 – ident: 3894_CR4 – ident: 3894_CR8 – volume: 7 start-page: s405 issue: 12 suppl 3 year: 2003 ident: 3894_CR19 publication-title: Int J Tuberc Lung Dis contributor: fullname: Lw Yun – volume: 5 start-page: 432 year: 2001 ident: 3894_CR24 publication-title: Int J Tuberc Lung Dis contributor: fullname: T Rodrigo – ident: 3894_CR2 – volume-title: HIV-AIDS and communication for Behavior and Social Change: Programme Experiencies, Examples and the Way Forward, Geneva year: 2001 ident: 3894_CR30 contributor: fullname: UNAIDS – volume: 73 start-page: 147 issue: 2 year: 2002 ident: 3894_CR29 publication-title: Lepr Rev contributor: fullname: JD Porter – volume-title: Attention to immigrant: the flood to the reasonable solution. Spanish Society of Family and Community Medicine year: 2002 ident: 3894_CR25 contributor: fullname: JL Cañada – volume: 54 start-page: 1 issue: RR-15 year: 2005 ident: 3894_CR9 publication-title: MMWR Rwcomm Report contributor: fullname: Centers for Diseases control an Prevention – volume: 121 start-page: 549 year: 2003 ident: 3894_CR10 publication-title: Med Clin doi: 10.1016/S0025-7753(03)74012-3 contributor: fullname: UITB, SEPAR, GESIDA, SEIMC,SESP – volume-title: Applying the BEHAVE framework: A Workshop on Strategic Planning for Behavior Change, Facilitator and Participant Guides year: 2004 ident: 3894_CR28 contributor: fullname: Core group – volume: 47 start-page: 1 issue: RR-16 year: 1998 ident: 3894_CR21 publication-title: Report of the Working Group on Tuberculosis among Foreign-Born Persons contributor: fullname: Centers for Disease Control and Prevention – ident: 3894_CR7 – ident: 3894_CR5 – volume-title: Broadening the case definition of tuberculosis in the national network of epidemiological surveillance year: 2003 ident: 3894_CR11 contributor: fullname: Health Institut Carlos III – volume: 19 start-page: 1405 issue: 5 year: 2003 ident: 3894_CR22 publication-title: Cad Saude Publica doi: 10.1590/S0102-311X2003000500019 contributor: fullname: AM Marques – volume: 86 start-page: 776 issue: 5 year: 2009 ident: 3894_CR20 publication-title: J Urban Health doi: 10.1007/s11524-009-9378-z contributor: fullname: RJ Asghar – volume-title: Peer education and VIH/SIDA: Concepts, uses and problems year: 1999 ident: 3894_CR18 contributor: fullname: UNAIDS – ident: 3894_CR1 – volume-title: R: A language and environment for statistical computing year: 2007 ident: 3894_CR16 contributor: fullname: R Development Core Team – ident: 3894_CR26 – ident: 3894_CR3 – volume-title: Information, education and comunication culturally appropriate. Cultural perspective of HIV/AIDS attention and prevention. Special collection of methodology manuals No. 1. Division of cultural politics and intercultural dialogue year: 2003 ident: 3894_CR27 contributor: fullname: UNESCO – volume: 8 start-page: 1545 year: 1994 ident: 3894_CR23 publication-title: Tuberculosis Section, International Union Against Tuberculosis and Lung Disease contributor: fullname: HL Rieder – ident: 3894_CR15 – start-page: 12 volume-title: Working with communities. Education and training. Aids action year: 1996 ident: 3894_CR31 contributor: fullname: J Dick – volume: 112 start-page: 151 year: 1999 ident: 3894_CR12 publication-title: Med Clin Barcelona contributor: fullname: UITB – ident: 3894_CR17 – ident: 3894_CR13 – volume-title: Towards a model to manage diversity. Electronic Clinic Journal in Primary Care (RCEAP). Vol. 3. Migration and health year: 2004 ident: 3894_CR14 contributor: fullname: JE Ospina – volume: 80 start-page: 445 issue: 6 year: 2002 ident: 3894_CR32 publication-title: WHO Bulletin contributor: fullname: MA Islam |
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| Snippet | The important increase in immigration during recent years has changed the epidemiology and control strategies for tuberculosis (TB) in many places. This study... Background The important increase in immigration during recent years has changed the epidemiology and control strategies for tuberculosis (TB) in many places.... Doc number: 158 Abstract Background: The important increase in immigration during recent years has changed the epidemiology and control strategies for... Background: The important increase in immigration during recent years has changed the epidemiology and control strategies for tuberculosis (TB) in many places.... BACKGROUNDThe important increase in immigration during recent years has changed the epidemiology and control strategies for tuberculosis (TB) in many places.... BACKGROUND: The important increase in immigration during recent years has changed the epidemiology and control strategies for tuberculosis (TB) in many places.... Abstract Background The important increase in immigration during recent years has changed the epidemiology and control strategies for tuberculosis (TB) in many... |
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| SubjectTerms | Adolescent Adult Child Child, Preschool Community health aides Community Health Workers Contact Tracing Control Demographics Distribution Emigrants and Immigrants Epidemiology Female Field study Health aspects Health care policy Humans Infant Intervention Male Middle Aged Mortality Multivariate Analysis Mycobacterium Noncitizens Nurses Professional Role Public health Spain Statistical analysis Substance abuse treatment Tuberculosis Tuberculosis, Pulmonary - diagnosis Tuberculosis, Pulmonary - transmission Young Adult |
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| Title | Community health workers improve contact tracing among immigrants with tuberculosis in Barcelona |
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