A step forward in tuberculosis elimination: implementing migrant latent tuberculosis screening and treatment in Oman

Abstract

Objectives

This study aimed to outline the process of implementation of latent tuberculosis (TB) infection (LTBI) screening among migrants using interferon-γ release assay (IGRA), describe the LTBI treatment protocol and cascade of care, and highlight success factors and challenges.

Design

This is a description of the process of implementation of screening of TB infection through a medical fitness program for residency, using primary care treatment module and short regimen.

Results

Before 2018, expatriates seeking residency employment in Oman undergo two-step medical fitness examination process that mainly rely on chest X-ray (CXR) before arrival and physical examination after arrival, with 15% random sample repeated. In 2018, Oman implemented CXR screening for all alongside symptom checks. With further surge of TB cases after COVID-19, screening using IGRA was introduced through a medical fitness program in 2024. Those who are IGRA-positive or indeterminate will proceed to CXR with subsequent referral to primary care for short regimen treatment (3 months of daily rifampicin plus isoniazid and pyridoxine) if eligible.

Conclusions

Oman aims to achieve sustainability through establishing an integrated LTBI screening for migrants within the residency medical fitness program using integrated electronic system, highly sensitive test, public private model (under government regulation), and high throughput testing methods. Treatment using a short regimen (3 months of daily rifampicin plus isoniazid) through primary care will improve treatment adherence, improve outcome, and reduce TB incidence.