Strengthening the Prevention, Detection, and Treatment of Diseases affecting US-bound Refugees and Other Globally Mobile Populations

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OVERALL PROJECT SUMMARY Under technical guidance the Centers for Disease Control and Prevention, the Migration Health Division of the International Organization for Migration (IOM) performs essential pre-departure activities for U.S.-bound refugees and immigrants to ensure they are fit to travel, that they receive cost-effective public health interventions, and that communicable diseases of public health significance are identified, managed, and reported. These activities comprise health assessments, which include screening and treatment for tuberculosis (TB) and other infectious diseases, additional evaluations for those with significant medical conditions, vaccinations and presumptive treatment, pre-embarkation checks, and outbreak response. As global mobility continues to accelerate, improved understanding, prevention, detection, and treatment of diseases affecting such populations is increasingly important for the health of individuals and communities. We propose to three activities with the overall goal of strengthening pre-departure procedures and disease prevention and control (see appendix attachment for summaries): (A) Diagnosis and Follow-up of Plasmodium malariae Infections in U.S.-bound Refugees to Inform Presumptive Treatment Recommendations. Presumptive artemisinin-based combination therapy (ACT) is recommended for all U.S.-bound refugees from Sub-Saharan Africa prior to departure. Although thought to be effective against P. malariae, recent data suggest it may be inadequate. We will determine rates of ACT success against P. malaraiae in U.S.-bound refugees in Uganda, and other considerations to inform pre-departure guidelines. (B) Latent Tuberculosis Infection (LTBI) Testing and Voluntary Treatment for U.S.-Bound Refugees in Tanzania and U.S.-Bound Immigrants in Vietnam. A substantial number of immigrants and refugees arriving in the U.S. may have undiagnosed and untreated LTBI and some will go on to develop active TB disease. Given that LTBI treatment initiation and completion rates for refugees and immigrants after arrival in the U.S. are suboptimal, new strategies are wanted. We will assess the acceptability and feasibility of offering LTBI testing and treatment overseas during the health assessment. (C) A Rapid Point-of-Care Testing Strategy to Increase Presumptive Strongyloides Treatment of U.S.-bound Refugees in Sub-Saharan Africa. Standard diagnostics for Loa loa infection require laboratory testing that is not readily available. Many U.S.-bound refugees cannot be tested for loaisis and thus must be excluded from presumptive treatment for strongyloidiasis, putting them at risk for serious long-term sequelae. We will investigate the use of a smart phone-based microscope as a point-of-care test for loaisis. Together, these activities will contribute to protecting and improving the health of U.S.-bound refugees and immigrants, identifying best practices and provide evidence-based strategies for disease prevention and control, and reducing the risk of infectious disease importation into the U.S.