Improving the detection of infectious diseases in at-risk migrants with an innovative integrated multi-infection screening digital decision support tool (IS-MiHealth) in primary care: a pilot cluster-randomized-controlled trial

Ethel Sequeira-Aymar, Angeline Cruz, Miquel Serra-Burriel, Ximena di Lollo, Alessandra Queiroga Gonçalves, Laura Camps-Vilà, Marta M Monclus-Gonzalez, Elisa M Revuelta-Muñoz, Nuria Busquet-Solé, Susana Sarriegui-Domínguez, Aina Casellas, Maria Rosa Dalmau Llorca, Carina Aguilar-Martín, Constanza Jacques-Aviñó, Sally Hargreaves, Ana Requena-Mendez, CRIBMI (IS-MiHealth) Working Group, Ethel Sequeira-Aymar, Angeline Cruz, Miquel Serra-Burriel, Ximena di Lollo, Alessandra Queiroga Gonçalves, Laura Camps-Vilà, Marta M Monclus-Gonzalez, Elisa M Revuelta-Muñoz, Nuria Busquet-Solé, Susana Sarriegui-Domínguez, Aina Casellas, Maria Rosa Dalmau Llorca, Carina Aguilar-Martín, Constanza Jacques-Aviñó, Sally Hargreaves, Ana Requena-Mendez, CRIBMI (IS-MiHealth) Working Group

Abstract

Background: There are major shortfalls in the identification and screening of at-risk migrant groups. This study aims to evaluate the effectiveness of a new digital tool (IS-MiHealth) integrated into the electronic patient record system of primary care centres in detecting prevalent migrant infections. IS-MiHealth provides targeted recommendations to health professionals for screening multiple infections, including human immunodeficiency virus (HIV), hepatitis B and C, active tuberculosis (TB), Chagas disease, strongyloidiasis and schistosomiasis, based on patient characteristics (including variables of country of origin, age and sex).

Methods: A pragmatic pilot cluster-randomized-controlled trial was deployed from March to December 2018. Eight primary care centres in Catalonia, Spain, were randomly allocated 1:1 to use of the digital tool for screening, or to routine care. The primary outcome was the monthly diagnostic yield of all aggregated infections. Intervention and control sites were compared before and after implementation with respect to their monthly diagnostic yield using regression models. This study is registered on international standard randomised controlled trial number (ISRCTN) (ISRCTN14795012).

Results: A total of 15 780 migrants registered across the eight centres had at least one visit during the intervention period (March-December 2018), of which 14 598 (92.51%) fulfilled the criteria to be screened for at least one infection. There were 210 (2.57%) individuals from the intervention group with new diagnoses compared with 113 (1.49%) from the control group [odds ratio: 2.08, 95% confidence interval (CI) 1.63-2.64, P < 0.001]. The intervention centres raised their overall monthly diagnosis rate to 5.80 (95% CI 1.23-10.38, P = 0.013) extra diagnoses compared with the control centres. This monthly increase in diagnosis in intervention centres was also observed if we consider all cases together of HIV, hepatitis B and C, and active TB cases [2.72 (95% CI 0.43-5.00); P = 0.02] and was observed as well for the parasitic infections' group (Chagas disease, strongyloidiasis and schistosomiasis) 2.58 (95% CI 1.60-3.57; P < 0.001).

Conclusions: The IS-MiHealth increased screening rate and diagnostic yield for key infections in migrants in a population-based primary care setting. Further testing and development of this new tool is warranted in larger trials and in other countries.

© The Author(s) 2021. Published by Oxford University Press on behalf of International Society of Travel Medicine.

Figures

Figure 1
Figure 1
Flow chart of the study population. Asterisk indicates study population.
Figure 2
Figure 2
Monthly diagnostic rates of the intervention and control PCC before and after implementation, March 2018. Monthly diagnostic rate local regression lines (LOESS) of outcomes intervention (red) and control (blue) centres. HIV, human immunodeficiency virus; Hep-B, hepatitis B virus; Hep-C, hepatitis C virus; TB, tuberculosis; 95% CI, 95% confidence interval.

References

    1. Willekens F, Massey D, Raymer J, Beauchemin C. International migration under the microscope. Science 2016; 352:897–9.
    1. Study-group-on-the-reception-system . Report on the Reception of Migrants and Refugees in Italy. Rome, 2015. (1 June 2021, date last accessed).
    1. Greenaway C, Castelli F. Infectious diseases at different stages of migration: an expert review. J Travel Med 2019; 26:taz007. 10.1093/jtm/taz007.
    1. European Centre for Disease Prevention and Control . Assessing the burden of key infectious diseases affecting migrant populations in the EU/EEA. Stockholm: ECDC, 2014. doi: 10.2900/28792.
    1. Asundi A, Beliavsky A, Liu XJ et al. Prevalence of strongyloidiasis and schistosomiasis among migrants: a systematic review and meta-analysis. Lancet Glob Heal 2019; 7:e236–48.
    1. Requena-Méndez A, Aldasoro E, de Lazzari E et al. Prevalence of Chagas disease in Latin-American migrants living in Europe: a systematic review and meta-analysis. PLoS Negl Trop Dis 2015; 9:e0003540.
    1. Requena-Mendez A, Chiodini P, Bisoffi Z, Buonfrate D, Gotuzzo E, Munoz J. The laboratory diagnosis and follow up of strongyloidiasis: a systematic review. PLoS Negl Trop Dis 2013; 7:e2002.
    1. Requena-Mendez A, Buonfrate D, Bisoffi Z, Gutiérrez JM. Advances in the diagnosis of human strongyloidiasis. Curr Trop Med Reports 2014; 1:207–15.
    1. Requena-Méndez A, Albajar-Vinas P, Angheben A, Chiodini PL, Gascon J, Muñoz J. Health policies to control Chagas disease transmission un European countries: a 2013 update. PLoS Negl Trop Dis 2014;8:e3245. doi: 10.1371/journal.pntd.0003245. eCollection 2014 Oct.
    1. Greenaway C, Hargreaves S, Barkati S et al. COVID-19: exposing and addressing health disparities among ethnic minorities and migrants. J Travel Med 2020; 27:taaa113. 10.1093/jtm/taaa113.
    1. Seedat F, Hargreaves S, Nellums LB, Ouyang J, Brown M, Friedland JS. How effective are approaches to migrant screening for infectious diseases in Europe? A systematic review. Lancet Infect Dis 2018; 18:e259–71.
    1. Wikell A, Åberg H, Shedrawy J et al. Diagnostic pathways and delay among tuberculosis patients in Stockholm, Sweden: a retrospective observational study. BMC Public Health 2019; 19:151.
    1. Baggaley RF, Irvine MA, Leber W et al. Cost-effectiveness of screening for HIV in primary care: a health economics modelling analysis. Lancet HIV 2017; 4:e465–74.
    1. Hudelson P, Dominice Dao M, Perneger T, Durieux-Paillard S. A ‘migrant friendly hospital’ initiative in Geneva, Switzerland: evaluation of the effects on staff knowledge and practices. PLoS One 2014; 9:e106758.
    1. Abubakar I, Aldridge RW, Devakumar D et al. The UCL-Lancet Commission on Migration and Health: the health of a world on the move. Lancet 2018; 392:2606–54.
    1. Eborall H, Wobi F, Ellis K et al. Integrated screening of migrants for multiple infectious diseases: qualitative study of a city-wide programme. EClinicalMedicine 2020; 21:100315. 10.1016/j.eclinm.2020.100315.
    1. Van Der Werf J, Derrough T, Duffell E et al. European Centre for Disease Prevention and Control. Public health guidance on screening and vaccination for infectious diseases in newly arrived migrants within the EU/EEA. Stockholm: ECDC, 2018.
    1. Requena-Mendez A, Bussion S, Aldasoro E et al. Cost-effectiveness of Chagas disease screening in Latin American migrants at primary health-care centres in Europe: a Markov model analysis. Lancet Glob Heal 2017; 5:e439–47.
    1. Wikman-Jorgensen PE, Llenas-Garcia J, Shedrawy J et al. Cost-effectiveness of different strategies for screening and treatment of Strongyloides stercoralis in migrants from endemic countries to the European Union. BMJ Glob Heal 2020; 5:e002321. 10.1136/bmjgh-2020-002321.
    1. Greenaway C, Pareek M, Abou Chakra C-N et al. The effectiveness and cost-effectiveness of screening for latent tuberculosis among migrants in the EU/EEA: a systematic review. Euro Surveill 2018; 23:17–00543. 10.3390/ijerph15092013.
    1. Greenaway C, Makarenko I, Chakra CNA et al. The effectiveness and cost-effectiveness of hepatitis C screening for migrants in the EU/EEA: a systematic review. Int J Environ Res Public Health 2018; 15:2013. doi: 10.3390/ijerph15092013.
    1. Greenaway C, Pareek M, Abou CNC et al. The effectiveness and cost-effectiveness of screening for active tuberculosis among migrants in the EU/EEA: a systematic review. Euro Surveill 2018; 23:17–00542. 10.2807/1560-7917.ES.2018.23.14.17-00542.
    1. Van Dort BA, Zheng WY, Sundar V, Baysari MT. Optimizing clinical decision support alerts in electronic medical records: a systematic review of reported strategies adopted by hospitals. J Am Med Inform Assoc 2021; 28:177–83.
    1. Sutton RT, Pincock D, Baumgart DC, Sadowski DC, Fedorak RN, Kroeker KI. An overview of clinical decision support systems: benefits, risks, and strategies for success. NPJ Digit Med 2020; 3:17. doi: 10.1038/s41746-020-0221-y. eCollection 2020.
    1. Bryan C, Boren SA. The use and effectiveness of electronic clinical decision support tools in the ambulatory/primary care setting: a systematic review of the literature. Inform Prim Care 2008; 16:79–91.
    1. Konerman MA, Thomson M, Gray K et al. Impact of an electronic health record alert in primary care on increasing hepatitis C screening and curative treatment for baby boomers. Hepatology 2017; 66:1805–13.
    1. Instituto de Estadística de Catalunya . El municipio en cifras, 2019. (25 October 2020, date last accessed).
    1. Alvarez-del Arco D, Fakoya I, Thomadakis C et al. High levels of postmigration HIV acquisition within nine European countries. AIDS 2017; 31:1979–88.
    1. Sequeira-Aymar E, diLollo X, Osorio-Lopez Y, Gonçalves AQ, Subirà C, Requena-Méndez A. Recommendations for the screening for infectious diseases, mental health, and female genital mutilation in immigrant patients seen in Primary Care. Aten Primaria 2020; 52:193–205.
    1. Pottie K, Lotfi T, Kilzar L et al. The effectiveness and cost-effectiveness of screening for HIV in migrants in the EU/EEA: a systematic review. Int J Environ Res Public Health 2018; 15:1700. doi: 10.3390/ijerph15081700.
    1. NHS . Tuberculosis: Migrant Health Guide, 2017. (25 October 2020, date last accessed).
    1. Agbata EN, Morton RL, Bisoffi Z et al. Effectiveness of screening and treatment approaches for schistosomiasis and strongyloidiasis in newly-arrived migrants from endemic countries in the EU/EEA: a systematic review. Int J Environ Res Public Health 2018; 16:11. doi: 10.3390/ijerph16010011.
    1. United Nations - Statistics Division . Standard Country or Area Codes for Statistical Use (M49), 2020. (25 October 2020, date last accessed).
    1. Domínguez-Berjón F, Borrell C, Rodríguez-Sanz M, Pastor V. The usefulness of area-based socioeconomic measures to monitor social inequalities in health in Southern Europe. Eur J Public Health 2006; 16:54–61.
    1. Requena-Méndez A. The CRIBMI - Explicative Video, 2019. (1 June 2021, date last accessed).
    1. Noori T, Hargreaves S, Greenaway C et al. Strengthening screening for infectious diseases and vaccination among migrants in Europe: what is needed to close the implementation gaps? Travel Med Infect Dis 2020; 101715.
    1. Donisi A, Gerna L, Fietta T, Grecchi C. Screening approach among newly arrived asylum seekers: experience in a primary health care setting in Piacenza, Emilia Romagna, Northern Italy. J Prev Med Hyg 2020; 61:E445–E450.
    1. Pezzi C, Lee D, Kumar GS et al. Health screenings administered during the domestic medical examination of refugees and other eligible immigrants in nine US states, 2014–2016: a cross-sectional analysis. PLoS Med 2020; 17:e1003065. doi: 10.1371/journal.pmed.1003065. eCollection 2020 Mar.
    1. Hargreaves S, Seedat F, Car J et al. Screening for latent TB, HIV, and hepatitis B/C in new migrants in a high prevalence area of London, UK: a cross-sectional study. BMC Infect Dis 2014; 14:657.
    1. Hargreaves S, Nellums LB, Johnson C et al. Delivering multi-disease screening to migrants for latent TB and blood-borne viruses in an emergency department setting: a feasibility study. Travel Med Infect Dis 2020; 36:101611.
    1. Quispel C, Schneider TAJ, Bonsel GJ, Lambregtse-Van Den Berg MP. An innovative screen-and-advice model for psychopathology and psychosocial problems among urban pregnant women: an exploratory study. J Psychosom Obstet Gynecol 2012; 33:7–14.

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