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 infectious diseases(IDs) and female genital mutilation/cutting(FGM/C) screening, and vaccination 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 level; 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 human immunodeficiency virus(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. 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, while Chagas disease only to childbearing-age women from endemic countries. Both regions recommended active TB screening for newly-arrived migrants(<5years) from TB-incidence countries≥50cases/100,000population. Almería added latent TB screening in 16-35-years-old migrants.

Conclusions: We tailored the implementation of the screening recommendations to migrations' profiles and healthcare contexts, which can enhance healthcare provision for migrants.

Keywords: Adaptation; Female Genital Mutilation; Infectious Diseases; Migrants; Practice Guideline; Primary Health Care; Screening.