Adapting the implementation of clinical practice guidelines for the screening of infectious diseases and female genital mutilation/cutting in migrants in Spain

Abstract

Objectives We aimed to adapt the implementation of vaccination and infectious diseases (IDs) and female genital mutilation/cutting (FGM/C) screening recommendations for migrants in two Spanish primary care settings, Catalonia and Almería.

Methods We refined the ADAPTE framework and conducted a literature review of IDs and FGM/C screening and vaccination guidelines (2003-2022) at international, national, and regional levels, two consensus workshops with multidisciplinary teams for recommendations alignment, and a survey to evaluate participants’ level of agreement.

Results The target migrant population was defined, and HIV, hepatitis B (HBV) and C virus (HCV), active tuberculosis (TB), schistosomiasis, strongyloidiasis, Chagas disease, and FGM/C were included in the screening recommendations. In Almería, syphilis, latent TB, and intestinal parasites were also included. However, vaccination was not included at either study site. Both settings agreed to test migrants from high-endemic countries for HBV (prevalence ≥2%), schistosomiasis, strongyloidiasis, and FGM/C. The Catalonia team agreed to test migrants from high-endemic countries for HIV (prevalence >1%), HCV (prevalence ≥2%), and Chagas disease. In Almería, participants agreed to offer universal testing to all migrants for HIV, HCV, and syphilis, whereas Chagas disease was only offered to childbearing-age women and migrants at risk of immunosupression from endemic countries. Both regions recommended active TB screening for newly arrived migrants (<5 years) from TB-incidence countries with ≥50 cases/100,000 population. Almería added latent TB screening in 16-35-year-old migrants.

Conclusions We tailored the implementation of the screening recommendations to the migrant profiles and health care contexts, which can enhance health care provision for migrants.

The ISMiHealth project is supported by a grant from “Instituto de Salud Carlos III (ISCIII) ,”co-financed by the European Regional Development Fund (FEDER) from the European Union, through the “Fondo de Investigación para la Salud (FIS) ,”grant number PI21/00651 . ISGlobal acknowledges support from the grant CEX2018-0 0 0806-S funded by MCIN/AEI/ 10.13039/50110 0 011033 and support from the Generalitat de Catalunya through the CERCA Program. ACz is funded by ISCIII co-financed by FEDER from the European Union through the “Contratos predoctorales de formación en investigación (PFIS),”grant number FI22/00156. ARM re- ceives support of a fellowship from “la Caixa”Foundation (ID: LCF/BQ/PI23/11970018). The funders of the study had no role in the study.