Evidence on tuberculosis in migrants at Brazil's international borders: A scoping review.

Objective: to map scientific evidence on the extent of tuberculosis in migrants from the international borders between Brazil and the countries of South America. Design: Scoping review of quantitative, qualitative and mixed studies. The research was conducted between February and April 2021. The terms "migrants", "tuberculosis", "Brazil", "Uruguay", "Paraguay", "Bolivia", "Peru", "British Guiana" "English Guiana", "French Guiana", "Suriname", "Venezuela", "Argentina", "Colombia" combined with Boolean operators "AND" and "OR" to identified relevant documents. Studies addressing tuberculosis on migrants from international borders of Brazil were included. Pubmed Central (PMC), LILACS (Scientific and technical literature of Latin America and the Caribbean/BVS), Scopus (Elsevier), Scielo (Scientific Electronic Library Online) and gray literature CAPES thesis database were searched. The study was carried out in three stages where the data was selected and extracted by two independent reviewers for full reading. Results: A total of 705 articles were extracted from the databases chosen for the search, 04 master's dissertations and 01 doctoral thesis. Of these 456 were excluded because they did not meet at least one of the eligibility criteria for this SR and 4 were further excluded because they were duplicates who had not been previously identified. A total of 58 documents were, thus, selected for assessment of the full text. Of these, 40 were further excluded for not meeting at least one of the eligibility criteria. A total of 18 studies were included for data collection: 15 articles, 2 master's dissertations and 1 doctoral thesis, produced between 2002 and 2021. Conclusion: This scoping review mapped the existing evidence on tuberculosis at the international borders of Brazil and on access of immigrants with tuberculosis to health services in Brazil. Descriptors: tuberculosis; immigrants; public health surveillance; epidemiological surveillance; sanitary control of borders; health services accessibility.

Epidemiology of TB in prisoners: a metanalysis of the prevalence of active and latent TB.

BACKGROUND: Tuberculosis (TB) in prisons usually occurs at higher rates than in the general population, especially in developing countries. TB has been reported as the most common cause of death among prisoners. Studies have shown limitations for early detection of TB in prisons that seem to result from mistaken concepts about TB, delayed diagnosis mainly due to the naturalization of lack of healthcare for this population METHODS: A scoping review was performed using the methodology of the Joanna Briggs Institute to assess "What are the scientific evidences on the epidemiology of TB in the prison system?". Then, a meta-analysis was performed to assess the prevalence of TB (active and latent) TB in prisoners. The results are presented as prevalence, in percentage, through random effects models, with a confidence interval of 95%. RESULTS: Regarding active TB, the results of the metanalysis showed that countries with a high burden of TB had a prevalence of 3.54% [2.71; 4.63], countries not considered to be high burden TB countries had a prevalence of 1.43% [0.86; 2.37]. Latent TB had a prevalence of 51.61% [39.46; 63.58] in high TB burden countries and a prevalence of 40.24% [23.51; 59.61] in countries with low TB burden. In terms of development, in low- and lower-middle-income countries, the prevalence of active TB was 3.13% [1.84; 5.29] and in high- and upper-middle income countries the prevalence was 2.25% [1.70; 2.99]. The prevalence of latent TB in high- and middle-income countries was 43.77% [28.61; 60.18] and of 49.42% [45.91; 52.94] in low and lower middle-income countries. CONCLUSION: Our analysis suggests that TB, and probably other infectious diseases, find fertile ground in prisons where previous acquire social disadvantages seem to thrive-therefore, TB in prisons is a global public health problem and effective strategies are needed to control the disease are needed targeting the prison environment, including rapid health assessments to understand each context and to implement tailored and precision interventions.

Inequities between migrants and non-migrants with TB: Surveillance evidence from the Brazilian border State of Roraima.

Introduction: Until 2014, there was already a significant burden of TB in Roraima, with this State being among the most affected ones in Brazil. Since 2015, though, there has been a progressive increase in cases of TB in the state of Roraima, with a notorious concentration of cases in Venezuelan migrants. Active international migration in border territories should be seen as a warning signal about the need to strengthen health surveillance and One Health actions that encompass all components involved in the risk of active transmission of diseases as tuberculosis in these scenarios. Objective: This study aims to analyze and compare migrants and non-migrants notified with TB in the State of Roraima in Brazil and identify inequities in terms of diagnosis, access to treatment and outcome of the disease. Study design: Quantitative, cross-sectional, descriptive study of all confirmed cases of TB notified in the Information System for Notifiable Diseases (SINAN) between 2009 and 2019. Methods: Data were described through counts, frequencies, prevalence ratios and 95% confidence interval. We used Poisson regression with robust variance to adjust for confounders. Results: 2111 cases of TB were reported in Roraima between 2009 and 2019 and in this study (mean age 38.2 ± 18.5 years). Cases were more frequently males, brownish race, indigenous people, with high school level education. 10.9% (n = 181) of TB cases were migrants, mainly from Venezuela (72.9%). Migrants with TB were more prone to be homeless (PR = 3.7). A higher number of cases of readmission after treatment dropout (3.3%) and AIDS diseases (11.2%) was observed among migrants compared to non-migrants. The proportion of DR-TB was higher among migrants. The percent of cure of TB was lower among migrants and the prevalence of abandonment of treatment, transfers and deaths by other causes was higher compared to non-migrants. Conclusions: The results of the study have shown considerable differences in the epidemiological profile of TB between migrants and non-migrants living in the State of Roraima, with a tendency for poorer outcomes in the first ones as well as more concentration of vulnerabilities. These results stress out existing inequities between migrants and non-migrants with TB disease and raise questions on the health care network capacity to address these.

Impact of COVID-19 on Tuberculosis Indicators in Brazil: A Time Series and Spatial Analysis Study.

BACKGROUND: We aimed to visualize and classify the time series of COVID-19, tuberculosis (TB) notification, and TB outcomes (cure, treatment abandonment, and death), verify the impact of the new coronavirus pandemic on these indices in Brazil, and verify the presence of spatial autocorrelation between COVID-19 and TB. METHODS: This was an ecological time series study that considered TB and COVID-19 cases. Seasonal Trend Decomposition using Loess (STL) was used to trace the temporal trend, Prais-Winsten was used to classify the temporal trend, Interrupted Time Series (ITS) was used to verify the impact of COVID-19 on TB rates, and the Bivariate Moran Index (Global and Local) was used to verify the spatial autocorrelation of events. RESULTS: Brazil and its macro-regions showed an increasing temporal trend for the notification of TB in the pre-pandemic period. Only the Northeast Region showed a decreasing temporal trend for cured cases. For treatment abandonment, all regions except for the Northeast showed an increasing temporal trend, and regarding death, Brazil and the Northeast Region showed an increasing temporal trend. With the ITS, COVID-19 caused a decline in TB notification rates and TB outcome rates. With the global spatial analysis, it was possible to identify the existence of spatial autocorrelation between the notification rate of COVID-19 and the TB notification rate and deaths. With the local analysis, it was possible to map the Brazilian municipalities and classify them according to the relationship between the rates of both diseases and space. CONCLUSIONS: COVID-19 influenced the follow-up of and adherence to TB treatment and intensified social vulnerability and, consequently, affected the notification of TB since the relationship between the disease and social determinants of health is already known. The restoration and strengthening of essential services for the prevention and detection of cases and treatment of TB in endemic environments such as Brazil have been oriented as a priority in the global health agenda.