Tuberculosis control among immigrants

The results in this thesis suggest a revision of the Dutch immigrant TB screening program. LTBI screening at entry rather than screening for TB only is expected to improve the cost-effectiveness. We provided evidence that the QFT-GIT could be a useful tool in this respect, but also the TST could perform well. An implementation study is needed to gain more insight in the preferred screening and preventive treatment strategy. The effectiveness of contact investigations involving immigrant contacts should be improved by updating guidelines with explicit recommendations and a comprehensive dissemination strategy, and by training PHNs. Future developments could further target these TB control activities and could contribute to a decline in TB incidence among immigrants.