Description
Introduction. Migrant and refugee health is a challenging task for healthcare professionals. The difficult migratory path makes this population particularly vulnerable at both health and social level. Therefore, a multidisciplinary team has been defined, including specialists in infectious diseases, dermatologists, gynaecologists, obstetricians, psychologists and specialists in preventive medicine. Since 2016 in Italy, the Public Health Departments managed medical visits and screening for infectious diseases among asylum seekers. In particular, in Modena province (Northern Italy), asylum seekers receive a first visit, including medical and psychological assessment and screening for infectious diseases. Ad hoc pathways are also active for asylum seekers who need secondary-level care. This study aims to evaluate the health status and prevalence of HBV, HCV, HIV, active tuberculosis (TB), latent TB infection (ILTB) and syphilis among asylum seekers hosted in Modena in 2021-2022.
Methodology. Asylum seekers referred to the Modena Centre during 2021 -2022 were included in the study using a retrospective cohort design. We used a tool shared by the Emilia-Romagna Region to record socio-demographical and clinical data and results from blood test for HIV, HBV, HCV and syphilis (RPR+TPPA to assess positivity). A three-level active surveillance system was adopted for TB and ILTB: all participants underwent an initial screening with tuberculin skin test (TST) and a psychological questionnaire during the first visit. Those with positive results underwent a blood test for QuantiFERON-TB (QTF). If QTF resulted positive, they underwent a chest X-Ray and a pneumologist visit. Descriptive statistics were used to analyse data.
Results. A total of 423 migrants were enrolled. The majority were men (N=275; 87.0%) and were from Sub-Saharan Africa (N=141; 33.3%), followed by Bangladesh/India (N=135; 31.9%), Pakistan/Afghanistan/Iraq (N=80; 18.9%) and Nord Africa (N=67; 15.8%). All women were from Sub-Saharan Africa. The median age was 25 years (min=3; max=49). The most frequent signs and symptoms detected were related to cutaneous disease (N=97; 22.9%), followed by gastrointestinal (N=19; 4.5%), cardiovascular (N=10; 2.4%) and respiratory diseases (N=4; 1.0%). Following medical evaluations, a specialist visit was requested for 25 subjects (5.9%), the other problems have been treated at the primary care level. 306 migrants underwent screening for infectious diseases. HbsAg positivity was 4.3% (N=13), HCVAb 1.0% (N=3), HIVAb 1.0% (N=3), TPPA+RPR positivity 1.0% (N=3). Mantoux test was positive in 120 subjects (39.2%). Of them, 79 (65.8%) had also QTF positive. All subjects with QTF positive underwent X-Ray exam and pneumological evaluation. Only one subject had active tuberculosis, the others were preventively treated for ILTB.
Conclusions. The innovative aspect of this protocol for migrants' health is the multidisciplinary context. At the primary care level, medical examination and screening tests performed shortly after asylum seekers' arrival guarantee the management of pathologies that would often remain undiagnosed and untreated, including second-level paths with team specialists. Finally, the collection of socio-demographic and clinical data will help to guide health policies’ choices to protect vulnerable individuals and implement public health programs.
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