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Tuberculosis screening among migrants: a qualitative study on healthcare seeking behaviour and acceptance of tongue swabs 

F Saluzzo(1,2) R Codsi(3) G Russo(2) R C Wood(3) A M Olson(3) K N O'Laughlin(4) D Rao(4) A E Shapiro(4,5) G A Cangelosi(3) D M Cirillo(2)

1:Universita Vita-Salute San Raffaele; 2:San Raffael Scientific Institute; 3:Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA,; 4:Department of Global Health University of Washington, Seattle, WA, USA; 5:Department of Medicine (Infectious Diseases) University of Washington, Seattle, WA, USA

TB screening in migrants is challenged by a reliance on sputum-based testing and hesitation to seek care.  In Italy, a key country of the migration route to Europe, almost half of TB cases are of foreign origin. The need for more comprehensive and accepted TB screening methods serving these migrants’ communities emerged. This study aims to evaluate the feasibility and acceptability of a non-sputum option, supervised self swabbing (SSS) for TB screening within the context of migrants' health care seeking behaviors. SSS have a reported sensitivity up to 95% when paired with appropriate laboratory methods. 

This user experience study uses qualitative research methods with in-depth interviews and purposive sampling. Recruitment of migrants experiencing TB screening began in November 2023 in Milan, Italy and continues until saturation among themes is reached. Hamilton’s Rapid Qualitative Analysis Method was adapted to summarize key findings.

Preliminary results from the first 12 people interviewed reveal barriers and facilitators to seeking care and using SSS. All migrants had limited knowledge of the TB screening process and TB signs and symptoms. All participants were able to self perform the tongue swab even if they had limited or no experience of self testing. Most participants (8/12) indicated STS was easier than sputum while (3/12) had no differential preference. Only one participant from Mali preferred sputum over SSS. 

These preliminary results indicate that SSS is feasible and acceptable. There is a lack of SSS educational materials and health promotion campaigns that are targeted to migrants' needs.

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