Evaluating the ‘cascade of care’ for latent tuberculosis infection (LTBI) among children: a platform for evidence-based approaches to TB elimination
Dr Greg Fox, A/Prof Justin Denholm
The overwhelming majority of tuberculosis (TB) in Australia occurs among migrant populations 1. Sensitive pre-migration screening enables most active TB to be detected and treated prior to arrival. However, pre-migration screening and treatment of latent TB infection (LTBI) has not previously been recommended, meaning that reactivation of LTBI is a key driver of TB
epidemiology in Australia. In order to realise the Australian Government’s vision for TB Elimination (defined as less than one case per million), migrant populations with LTBI will need to be treated 2. In November 2015, the Department of Immigration and Border Protection (DIBP) introduced LTBI screening for all permanent, protection and provisional visa applicants aged from 2 to 10 years from countries with a TB incidence of at least 40 per 100,000 (V Sheppeard, correspondence). The Child LTBI Screening Policy (CLSP) was based upon a similar scheme in the USA, aiming to reduce TB among young children exposed to infectious cases prior to migration 3. In its first twelve months, the program screened over 20,000 children (P Douglas, World Lung Conference 2016). However, the health and financial consequences of this program for Australian health systems, and
migrants themselves, remain uncertain. Understanding the effectiveness and of this program and its wider impacts will be critical in planning future strategies to enhance TB control in Australia. This project aims to evaluate the implementation and costs of this new policy, and contribute to the evidence base upon which future TB elimination strategies can be based.
Aims & Objectives
Specifically, this project aims to:
1. Evaluate the ‘cascade of care’ for the pre-migration screening and treatment of children for LTBI during the initial stage of the Child LTBI Screening Policy.
2. Establish the costs of screening and follow-up of children, from a health systems perspective
3. Obtain pilot data for a future NHMRC-funded grant application to evaluate the costeffectiveness of alternative TB elimination strategies in Australia