Conselho Directivo/Outros órgãos estatutários e Serviços de Apoio
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- European guidelines for the management of tuberculosis screening procedures in migrants: A systematic reviewPublication . Pinheiro, Marina; Valente, Carolina; Cruz, Margarida; Nascimento Moreira, David; Aguiar, Ana; Duarte, RaquelBackground: This systematic review assesses the current available evidence across the WHO European region on the effectiveness and cost-effectiveness of the different approaches used for TB screening and also explores the facilitators and barriers that migrants face during screening programmes. Methods: We conducted an extensive, comprehensive, and systematic literature search across multiple databases, including MEDLINE, Cochrane, Scopus, and ISI Web of Knowledge, without any restrictions on publication date or language. In addition, we reviewed grey literature and reports. The data were meticulously analysed with a focus on screening of TB active disease and infection effectiveness indicators, and cost-effectiveness economic analyses as a primary objective and the comprehension of barriers and facilitators of screening as a secondary objective. Findings: Our review included 43 studies covering over 8 million migrants from 11 countries. The findings demonstrate that while screening uptake was high, coverage varied, and completion rates for preventive treatments were low. Economic analyses supported the high cost-effectiveness of the screening programmes, particularly when integrating both active TB and TBI screening strategies. Interpretation: This review underscores the cost-effectiveness and public health importance of TB screening in migrant populations within Europe. However, the disparities in screening practices highlight the urgent need for standardisation at the European level.
- Expert perspectives on tuberculosis screening procedures for migrantsPublication . Pinheiro, Marina; Moreira, David N.; Aguiar, Ana; Duarte, RaquelObjective: To evaluate the perspectives of tuberculosis experts from different countries regarding national screening procedures. Methods: This was a qualitative descriptive study. Data were collected by using electronic, anonymized surveys with experts in tuberculosis in seven different countries within two World Health Organization regions (Europe and Africa). Thematic analysis was employed. Results: The survey results indicate that there are varied perceptions of and experiences with national guidelines on screening for and treatment of tuberculosis (especially in the population tested), the appropriate timing of screening, types of tests, best practices, barriers, and limitations of the screening. The participants highlighted the importance of integrating health care services into the community to achieve people-centered health care. The study also sheds light on the importance of involving trained nurses and social workers in the screening process and of networks to ensure continuity of care. Conclusions: The overall perceptions of the respondents underscore the importance of standardized screening guidelines. The ongoing collaboration between public health services, the private sector, and the community is essential to reduce tuberculosis transmission, as well as to provide substantial public health and economic benefits.
- The Invisible Face of COVID-19Publication . Duarte, Raquel; Aguiar, AnaExtract: The COVID-19 pandemic has left indelible marks on the global landscape, disrupting lives, economies, and health systems. The immediate, visible consequences of the pandemic include overwhelmed healthcare systems, with hospitals stretched beyond capacity, leading to delayed care and strained resources¹,². Staggering mortality rates became a grim hallmark as COVID-19 claimed millions of lives worldwide. Economically, global lockdowns disrupted supply chains, shuttered businesses, and caused massive job losses, plunging countless families into financial insecurity³. The urgency of vaccine development and distribution brought hope and highlighted disparities in access, underscoring systemic inequities between high- and low-income countries. While these visible effects dominated public discourse, they represent only part of the pandemic’s multifaceted impact. A significant portion of its impact remains hidden beneath the surface. These invisible damages, often overshadowed by immediate crises, have profound implications for public health and societal resilience. Understanding these hidden consequences is essential to formulating effective recovery strategies and building resilience against future crises. Addressing both visible and invisible impacts is crucial for constructing a comprehensive narrative of the pandemic’s effects and implementing holistic solutions.
- A multinational Delphi consensus on tuberculosis screening of migrants in EuropePublication . Pinheiro, Marina; Aguiar, Ana; Moreira, David N.; Akkerman, Onno W.; Al-Suwaidi, Zubaida; Alffenaar, Jan-Willem C.; Arandjelović, Irena; Brito, Ulisses; de Colombani, Pierpaolo; Curcic, Radmila; Garcia-Basteiro, Alberto L.; Goletti, Delia; Günther, Gunar; Ibraim, Elmira; Kapata, Nathan; Lange, Christoph; Lipman, Marc; Jankovic Makek, Mateja; Marais, Ben J.; Mariandyshev, Andrei; Magis-Escurra, Cecile; Migliori, Giovanni Battista; Sánchez Montalvá, Adrián; Nanovic, Zorica; Palmero, Domingo Juan; Priwitzer, Martin; Raviglione, Mario C. B.; Silva, Denise Rossato; Salzer, Helmut J.F.; Schwarzbach, Christian; Spruijt, Ineke; Winthrop, Kevin L.; Udwadia, Zarir; Vasankari, Tuula; Vilaplana, Cristina; Duarte, RaquelThe disproportionate burden of tuberculosis among migrants in the World Health Organization (WHO) European Region underscores the urgent need to address the public health challenges associated with global migration. Recommendations for screening of pulmonary tuberculosis (TB) and TB infection (TBI) are highly variable across European countries, highlighting the need for standardised practices and coordinated efforts to reduce TB risk more effectively. This study aims to produce a harmonised set of recommendations to contribute to elaboration for policy action using the Delphi method. It brings together a multidisciplinary panel of 33 TB experts from academia, healthcare, non-governmental organisations and government agencies across 22 countries to formulate consensus-based recommendations. The panel created 19 consensus statements and 36 recommendations for governments, health systems and other stakeholders. The recommendations span four key domains: 1) policy, 2) health systems and health professionals, 3) screening procedures and priority populations and 4) continued treatment and care. This study recommends a unified, evidence-based approach to TB screening in migrants, with free access to diagnosis and treatment, culturally sensitive care, use of digital tools and coordinated efforts across health systems to ensure effective and equitable TB control in Europe. Thus, the experts emphasised key recommendations that strike a balance between immediate health system interventions, screening procedures and cultural inclusivity to more effectively address TB among migrants. The findings of this study offer actionable policies to address gaps and weaknesses in Europe's response to tuberculosis among migrants, advancing efforts to eliminate TB as a public health threat.
- Optimising non-pharmacological interventions in people with non-tuberculous mycobacterial pulmonary disease: a systematic reviewPublication . Sulaiman, Naif; Martins, Beatriz; Moreira-Sousa, Diana; Aguiar, Ana; Hurst, John R.; Brown, James; Duarte, Raquel; Lipman, MarcIntroduction: Treatment of non-tuberculous mycobacterial pulmonary disease (NTM-PD) is often complex, relying on long treatment courses with multiple antibiotics, which are associated with treatment intolerance and failure. Current guidelines provide limited insight into non-pharmacological treatment, which is believed to be an important component of symptom control and is related to treatment outcomes with an established evidence base in other chronic respiratory diseases. Methods: The authors conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify studies on non-pharmacological interventions for NTM-PD, focusing on airway clearance techniques, pulmonary rehabilitation, nutritional support and psychological care. Results: There was little evidence regarding the impact of non-pharmacological interventions in NTM-PD. We identified three studies that described a positive impact of airway clearance techniques, including oscillating positive expiratory pressure, chest physical therapy with devices such as Acapella and Flutter, as well as chest oscillatory techniques (e.g. Vest) and hypertonic saline nebulisation. We found no relevant studies in NTM-PD reporting the use of nutrition, pulmonary rehabilitation or psychological care as interventions in this group of patients. Conclusions: Non-pharmacological interventions show potential in managing NTM-PD, although significant evidence gaps remain. This review highlights the importance of expanding high-quality studies on the use of these interventions to people with NTM-PD.
- Safety, Efficacy, and Pharmacokinetics of Daily Optimized Doses of Rifampicin for the Treatment of Tuberculosis: A Systematic Review and Bayesian Network Meta-AnalysisPublication . Espinosa-Pereiro, Juan; Aguiar, Ana; Nara, Eva; Medina, Angelica; Molinas, Gladys; Tavares, Margarida; Tortola, Teresa; Ghimire, Samiksha; Alfenaar, Jan-Willem C.; Sturkenboom, Marieke G.G.; Magis-Escurra, Cecile; Sánchez-Montalva, Adrián; Barros, Henrique; Duarte, RaquelBackground: Higher than standard doses of rifampicin could improve the treatment outcome of drug-susceptible tuberculosis (TB) without compromising the safety of patients. Methods: We performed a systematic review of prospective clinical studies including adults with pulmonary and extrapulmonary TB receiving rifampicin doses above 10 mg/kg/day. We extracted the data on overall adverse events (AE), hepatic AE, sputum culture conversion (SCC) at week 8, recurrence, mortality, and pharmacokinetics. We performed a Bayesian network meta-analysis (NMA) using a random-effects model. Results: In 19 studies, 2033 out of 3654 participants received rifampicin doses higher than 10 mg/kg/day. The NMA showed an increased risk of overall and hepatic AE for the 40 mg/kg/day dose (risk ratio [RR] 4.8, 95% credibility interval [CrI]: 1.1, 25, and 15.00; 95% CrI: 1.1, 58.0, respectively), but no other doses, including 50 mg/kg/day showed such an increase. Increasing doses improved sputum culture conversion at week 8 (RR 1.3, 95% CrI: 1.1, 1.7 for SCC with 35 mg/kg/day). Conclusions: Optimal doses of rifampicin may be between 25 and 35 mg/kg/day, but should be tailored at the individual or, at least, at the population level.