Shaping a Community-based Pathway to Improve TB Surveillance Among African and Hindustan Immigrants Experiencing Vulnerabilities

Tuberculosis (TB) is an infectious disease primarily affecting the lungs but capable of spreading to other organs. Following infection, around 5% of those infected develop the disease in the first 2 years, while the others carry the bacteria but remain asymptomatic. TB infection (TBI) occurs when individuals are infected but do not show symptoms and are not contagious. In 2022, there were 10.6 million cases of TB, 1.3 million deaths due to TB worldwide and approximately 1.7 billion people globally were estimated to have TBI, representing a significant pool of potential future TB cases. Preventive treatment for TBI is crucial to reducing the risk of progression to active TB and is a key component of the World Health Organization's (WHO) End TB Strategy. Early diagnosis, effective treatment, and targeted interventions for groups at increased risk are essential to controlling both TB and TBI globally.

The number of TB cases in Portugal has been gradually decreasing. In 2016 the country was considered a low-incidence country (<20 TB cases per 100,000 inhab). Immigrants are among the groups experiencing higher TB burden, especially in low-incidence countries, dure to factors such as overcrowding, poor living conditions, and limited healthcare access during migration trajectory and in refugee camps. Immigrants accounted for 30.1% of TB cases in Portugal in 2022, with a notification rate 4 times higher than the national average (58.5 cases/100,000 inhab). The majority of TB cases in immigrants were from Angola, Brazil, Guinea-Bissau, and Cape Verde. In 2023, the number of immigrants increased by 34% compared to 2022 with more than a million documented immigrants living in the country and an estimated number of undocumented immigrants between 30,000 and 50,000. Seven of the nine most common nationalities of newly arrived immigrants are from high TB burden regions like Africa and Hindustan, i.e., Angola, Cape Verde, India, Guinea Bissau, Bangladesh and Nepal.

In Portugal, the current guidelines for TB surveillance and management identify immigrants as one of the key populations for targeted intervention and establish those from high incidence countries (i.e., Angola, Guinea-Bissau, Cabo Verde, Mozambique, Ukraine, Romania and Russia) should be screened. However, immigrants from Hindustan countries are not included despite growing significance in current immigration trends.

The overall aims of this project are to develop a community based, participatory, co-created TB/ TBI screening care path, to estimate the incidence of TB and TBI in African and Hindustan immigrants in Portugal and to understand how some of their social, health and economic vulnerabilities may influence TB risk and adherence to a cascade of TB/TBI screening care.

Aim: to develop a co-created TB/TBI screening care path to ensure immigrants are not left behind and that no one is left untreated.