COVID-19 Infection and Contact Tracing Among Refugees in the United States, 2020-2021.

Refugees in the United States are believed to be at high risk of COVID-19. A cross-sectional study design was utilized to collect anonymous, online surveys from refugee communities in the United States during December 2020 to January 2021. We invited bilingual community leaders to share the survey link with other refugees aged ≥18 years. We identified factors associated with COVID-19 infection and measured the distribution of contact tracing among those who tested positive. Of 435 refugees who completed the survey, 26.4% reported testing positive for COVID-19. COVID-19 infection was associated with having an infected family member and knowing people in one's immediate social environment who were infected. Among respondents who tested positive, 84.4% reported that they had been contacted for contact tracing. To prepare for future pandemics, public health authorities should continue partner with refugee community leaders and organizations to ensure efficient programs are inclusive of refugee communities.

Acceptance of COVID-19 Vaccine Among Refugees in the United States.

OBJECTIVE: Little is known about COVID-19 vaccination intentions among refugee communities in the United States. The objective of this study was to measure COVID-19 vaccination intentions among a sample of refugees in the United States and the reasons for their vaccine acceptance or hesitancy. METHODS: From December 2020 through January 2021, we emailed or text messaged anonymous online surveys to 12 bilingual leaders in the Afghan, Bhutanese, Somali, South Sudanese, and Burmese refugee communities in the United States. We asked community leaders to complete the survey and share the link with community members who met the inclusion criteria (arrived in the United States as refugees, were aged ≥18, and currently lived in the United States). We compared the characteristics of respondents who intended to receive the COVID-19 vaccine with those of respondents who did not intend to receive the vaccine or were unsure. We then conducted crude and adjusted logistic regression analysis to measure the association between employment as an essential worker and COVID-19 vaccine acceptance. RESULTS: Of 435 respondents, 306 (70.3%) indicated that they planned to receive a COVID-19 vaccine. Being an essential worker (adjusted odds ratio [aOR] = 2.37; 95% CI, 1.44-3.90) and male sex (aOR = 1.87; 95% CI, 1.12-3.12) were significantly associated with higher odds of intending to receive a COVID-19 vaccine. Among respondents who intended to receive a COVID-19 vaccine, wanting to protect themselves (68.6%), family members (65.0%), and other people (54.3%) were the main reasons. CONCLUSION: Many refugees who responded to the survey, especially those who worked in essential industries, intended to receive a COVID-19 vaccine. Community organizations, health care providers, and public health agencies should work together to ensure that vaccine registration and vaccination sites are accessible to refugees.

Enhanced Transitions of Care for Medically Complex Refugees.

BACKGROUND: Between 2015 and 2019, 261,091 refugees were resettled through the U.S. Refugee Admissions Program. Few are chronically ill, but previously these went to emergency rooms upon arrival. We designed a pilot program to anticipate, assess, and safely assume care of chronic health needs and stabilize sick and medically complex refugees upon arrival. CLINICAL OPERATIONS: Academic internal medicine and pediatrics clinics are linked to the Washington State Refugee Health Program and Refugee Resettlement Agencies. Arriving refugees deemed medically complex through overseas medical evaluation or post-arrival were selected for the program. METRICS: We reviewed biodata of 2,947 refugees deemed medically complex. We referred five hundred and sixty one (19%) of these for evaluation, and 257 (46%) of referrals received care. DISCUSSION: Safe transitions of care are standard practice in medical systems. This innovation in Seattle is one example of a system for the safe and cost-effective relocation of refugees with complex illnesses.

Correction: Evaluation of a multi-faceted diabetes care program including community-based peer educators in Takeo province, Cambodia, 2007-2013.

[This corrects the article DOI: 10.1371/journal.pone.0181582.].

Evaluation of a multi-faceted diabetes care program including community-based peer educators in Takeo province, Cambodia, 2007-2013.

INTRODUCTION: Early detection and treatment for diabetes are essential for reducing disability and death from the disease. Finding effective screening and treatment for individuals living with diabetes in resource-limited countries is a challenge. MoPoTsyo, a Cambodian non-governmental organization, addressed this gap by utilizing a multi-pronged approach with community-based peer educators, access to laboratory procedures, local outpatient medical consultation, and a revolving drug fund. This study evaluated outcomes of MoPoTsyo's diabetes program in Takeo Province by assessing glycemic and blood pressure outcomes for individuals diagnosed with diabetes over a 24-month follow-up period between 2007-2013. METHODS: This is a retrospective cohort analysis of records without a comparison group. We calculated the mean fasting blood glucose (FBG) and blood pressure (BP) at regular intervals of follow-up. The proportion of patients reaching recommended treatment targets for FBG and BP was assessed. RESULTS: Of the 3411 patients enrolled in the program, 2230 were included in the study. The cohort was predominantly female (68.9%) with a median age of 54 years. Median follow-up time in the program was 16 months (4.9-38.4 months). Mean FBG decreased 63.9 mg/dl in mean FBG (95% CI 58.5 to 69.3) at one year of follow-up (p<0.001). After one year, 45% (321/708) of patients achieved goal FBG < 126. Of the 41.6% (927/2230) with elevated BP at enrollment, systolic and diastolic BP levels significantly decreased (p<0.001) by 16.9 mmHg (95% CI 1.2 to 22.9) and 10 mm Hg (95% CI 0.7 to 12.9) respectively between enrollment and one year of follow-up. At one year of follow-up, 51.1%% (183/355) of these patients reached the BP goal < 140/90. CONCLUSION: The improved outcome indicators of diabetes care for MoPoTsyo's Takeo program evaluation showed promise. The program demonstrated a reasonable and practical approach to delivering effective diabetes care in a rural area and may serve as a model for other low-income communities. Future prospective evaluations with more complete data are necessary for longer-term outcomes.

Resistance to First-Line Antituberculosis Drugs in Washington State by Region of Birth and Implications for Latent Tuberculosis Treatment Among Foreign-Born Individuals.

The United States has a low burden of drug resistance among tuberculosis (TB) cases compared with other world regions. TB is increasingly concentrated among foreign-born individuals who have higher rates of drug resistance than U.S.-born individuals. While universal drug susceptibility testing is the standard for detecting active tuberculosis, there are limited guidelines for latent tuberculosis infection (LTBI) treatment based on risk factors for drug resistance. To quantify the variable risk of drug resistance among foreign-born individuals, all TB cases in Washington State between 1994 and 2014 with drug resistance data for isoniazid, rifampin, pyrazinamide, and ethambutol were divided into eight regions of birth. Logistic regression was used to characterize regional differences in resistance patterns. Genotypic cluster and lineage data were compared against drug resistance in a subanalysis. Among 4,298 cases, isoniazid resistance was more common in foreign-born individuals (12.6% versus 4.8%; P < 0.001), with the highest burden among individuals from the Asia-Pacific (14.8%) region. Rifampin resistance was slightly higher among foreign-born individuals (1.9% versus 1.1%; P = 0.063). Multivariate logistic regression demonstrated that older age was associated with a lower risk of resistance to isoniazid and rifampin (odds ratio [OR] = 0.86, P = 0.006 and OR = 0.64, P = 0.003 for each 20-year interval, respectively). These data suggest drug resistance in LTBI will remain a challenge and that rifampin-based regimens for treatment of LTBI in non-human immunodeficiency virus-infected adults may be preferable for individuals born in regions with high levels of isoniazid resistance. However, further research is needed to demonstrate whether LTBI treatment based on region of birth further decreases TB reactivation.

Seroprevalence of Hepatitis B Infection Among Immigrants in a Primary Care Clinic: A Case for Granular Ethnicity and Language Data Collection.

Chronic hepatitis B virus (HBV) infection is highly prevalent worldwide and is most often diagnosed through screening efforts. In order to identify the specific ethnic groups at greatest risk, it is necessary to go beyond traditional categories. We conducted a retrospective case series in a primary care clinic serving non-English speaking immigrants to determine the prevalence of HBV among patients of various primary spoken languages (used as a proxy for ethnicity). Among the 1378 patients, the overall prevalence of current infection was 8%. HBV infection was markedly higher among Somali, Oromo and Khmer speakerscompared to other groups. This study illustrates the use of granular language data in describing the serologic profiles of HBV infection among non-English speaking patients in primary care setting. The variations in prevalence by language have implications for public health HBV screening efforts, in addition to suggesting potential risk factors for transmission.

Care of Adult Refugees with Chronic Conditions.

Refugees share a common experience of displacement from their country of origin, migration, and resettlement in an unfamiliar country. More than 17 million people have fled their home countries due to war, generalized violence, and persecution. US primary care physicians must care for their immediate and long-term medical needs. Challenges include (1) language and cultural barriers, (2) high rates of mental health disorders, (3) higher prevalence of latent infections, and (4) different explanatory models for chronic diseases. This article discusses management strategies for common challenges that arise in the primary care of refugees.