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Migration and Tuberculosis

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Transcript of Migration and Tuberculosis

Emerging Concerns in TB and Migration
The Migration Process and TB Epidemiology
Emerging Concerns in TB and Migration
Emerging Concerns in TB and Migration
Migration and Tuberculosis
Migrants are particularly vulnerable to MDR-TB due to overcrowded living conditions, delayed diagnosis from financial constraints, poor health literacy and healthcare seeking behaviours, poor treatment adherence and high default rates. Without timely TB diagnosis, treatment, contact tracing and cross-border continuity of care for migrants, hard-to-reach mobile populations and surrounding communities, MDR-TB control will remain a challenge.

The individual’s health status, availability of and access to quality health systems, overall socioeconomic conditions and occurrence of any disease epidemics, emergencies – including famines and political conflicts – make up the migrant’s health and TB risks at origin. Discriminatory practices such as denial of work permits due to past TB history is also a concern in case of mandatory pre-departure medical examinations and a factor potentially undermining proper compliance with TB treatment.

The migratory journey affects the TB risk of migrants, especially when travel occurs under precarious conditions, for example, for irregular migrants and asylum-seekers.
Migrants’ integration into the host country’s health system (access, availability, affordability, and acceptability), their living and working conditions and socioeconomic status all influence the risks of contracting and effectively treating TB. Discriminatory practices such as deportation after positive TB diagnosis is another concern for migrants, while in the country of destination.

Migrants who lived in poor housing, received low wages and had limited access to health care are likely to return home less healthy than when they left. When migrants return to their place of origin with untreated TB, MDR-TB or complications thereof, the availability of standardized treatment and access to reliable health care services becomes an important factor in their health outcomes.
Multidrug resistant TB (MDR)
Forced displacement of persons after conflict or a natural disaster is often associated with an increased risk of TB due to factors such as malnutrition, overcrowding in camps or other temporary shelters, and disruption of health services resulting in the interruption of TB treatment that may result in drug resistance. There remains an ethical dilemma in postponing TB programmes until the social setting becomes more appropriate for implementation, and an analysis comparing the risks and benefits of delaying TB programmes in complex emergencies is needed.
Forced displacement
Migrant workers in the mining industry
Migrant workers in the mining industry are at a high risk for TB due to poorly ventilated, overcrowded living and working conditions and occupational hazards like silicosis. In Southern Africa, where a majority of mine workers are migrants from neighbouring countries, nearly one-third of the TB infections are estimated to be linked to mining activities. The underlying social and structural determinants of this largely disproportionate TB burden in the mining industry lies outside the traditional health sector, and it can only be addressed through sustained and multi-sectoral collaboration between ministries of labour, mining and health, as well as private industry.
The Migration Process and TB Epidemiology
The Migration Process and TB Epidemiology
At origin
During transit
At destination
The Migration Process and TB Epidemiology
Upon return
• Respect appropriate data protection and confidentiality principles for migrants and trafficked or detained persons, by creating secure interfaces between health and other migration data management mechanisms.

Addressing Tuberculosis among Migrants
Measurement and analysis of TB burden among migrants
• Establish cross-border referral systems with contact tracing and information sharing to ensure continuity of care for migrants and enhance harmonization of treatment protocols across borders along migration corridors.

Addressing Tuberculosis among Migrants
Robust migrant-sensitive health systems for an effective TB response
• Ensure policy coherence and shared solutions between health and non-health sectors such as immigration and labour , to implement the WHA 61.17 Resolution Health of Migrants, and support migrant TB programmes.
• Address migrant’s healthcare needs through specific public-private and regional frameworks, such as the Southern Africa Development Community (SADC) Declaration on TB in the mining sector.
Addressing Tuberculosis among Migrants
Intersectoral policy and legal frameworks—Health-in-all-policies approach
• Foster partnerships between various governmental sectors, private sectors (private healthcare providers, pharmaceutical companies, insurance sector, employers), civil society (including migrant groups), humanitarian and development agencies and the international donor community.

Addressing Tuberculosis among Migrants
Networks and multi-country partnerships with common goals
• Ensure that TB diagnostics, treatment and care for migrants are integrated within National TB programmes with dedicated resources, including MDR-TB and TB-HIV management and migrants’ access to innovative TB technologies and services.
• Support a rights-based health systems approach, sensitize medical and administrative personnel to health profiles of migrants and build cultural competency reflective of migrants’ needs.
• Build reliable country statistical systems to include disaggregated data on migrant types, and migration-related variables (in routine health data monitoring and TB prevalence surveys).
• Explicitly recognize migrants as a marginalized and disadvantaged group in post-2015 TB goals and targets.
• Promote political commitment in migrant-receiving countries for investments in targeted TB programmes in countries of origin and transit, especially in high TB incidence countries.
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