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 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 infectious diseases 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 hepatitis B virus (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.

Keywords: Adaptation; Female genital mutilation/cutting; Infectious diseases; Migrants; Primary health care; Screening guidelines.