Active Tuberculosis Surveillance in Migrant, Refugee, and Stateless Populations: An Integrated Approach for Early Detection, Adherence, and Care in Highly Vulnerable Territories

• Grant number: 25/01954-5
• Support Opportunities: Scholarships in Brazil - Master
• Start date: July 01, 2025
• End date: June 30, 2027
• Field of knowledge: Health Sciences - Nursing - Public Health Nursing
• Principal Investigator: Ricardo Alexandre Arcêncio
• Grantee: Beatriz Fornaziero Vigato
• Host Institution: Escola de Enfermagem de Ribeirão Preto (EERP). Universidade de São Paulo (USP). Ribeirão Preto , SP, Brazil

Abstract

Introduction: Tuberculosis (TB) is a serious public health problem, especially among migrants, refugees, and stateless persons (MIRA), due to socioeconomic factors and difficulties in accessing healthcare. Despite advances in diagnosis and treatment, TB remains the second leading cause of death worldwide, with a high incidence in developing countries. Mobility and stigmatization hinder treatment adherence among MIRA, making it essential to use innovative strategies such as VDOT (Video Directly Observed Therapy) for remote therapy monitoring. Objective: To promote the implementation of technologies for the screening and treatment adherence of tuberculosis disease among international migrants, refugees, and stateless persons. Method: This implementation science-based study will be conducted in Foz do Iguaçu. In partnership with Municipal Health Departments, trained physicians and nurses will follow standardized protocols for patient prescription and monitoring. Treatment adherence will be assessed using three strategies: Self-Administered Treatment (TA), conventional Directly Observed Treatment (DOT), and the use of VDOT. A total of 45 participants will be randomized into three groups, identified through state records, active case finding, and clinical evaluation, following the guidelines of the Ministry of Health and international standards. In addition to evaluating the effectiveness of adherence strategies, the study will analyze side effects, willingness to continue treatment, and participants' perceptions of treatment. The project will be submitted to the Research Ethics Committee of the Ribeirão Preto School of Nursing at the University of São Paulo (EERP/USP).