Tuberculosis infection prevalence and treatment completion among refugees in the United States

Identifying and treating tuberculosis infection (TBI) among refugees at elevated risk for developing TB disease is crucial for TB prevention and elimination in the United States (U.S.). However, current evidence is limited by small sample sizes, inclusion of refugees from only a single country, and/or reliance solely on the tuberculin skin test (TST).

Refugees in a large cohort study from 10 U.S. sites underwent evaluation for TBI using three available tests: the TST and two interferon-gamma release assays (IGRAs). This study calculated TBI prevalence and assessed tuberculosis preventive treatment (TPT) completion among refugees, defining TBI prevalence as positive results on at least two tests.

Among 8960 refugees enrolled July 2012 through May 2017, TBI prevalence was 23.2% (95% confidence interval [CI]: 22.4%-24.1%). Completion of TPT was 81.2% (95% CI: 79.6%-82.7%). Shorter treatment regimens of 3 months were associated with higher treatment completion compared to regimens of 6 months or longer.

The high TBI prevalence among refugees is a concern, but their high TPT acceptance and completion rates offer an opportunity. IGRA-based tests are preferred in this population; however, limited resources underscore the need for more precise screening approaches to better identify high-risk individuals who truly require TPT.