Peer Review #1 of "Surveillance of tuberculosis and treatment outcomes following screening and therapy interventions among marriage-migrants and labor-migrants from high TB endemic countries in Taiwan (v0.1)"

Background Tuberculosis (TB) among migrants from high-risk countries and underling interventions were concerned for disease control.This study aimed to assess the TB trends among marriage-migrants with the 1-2-round vs. labor-migrants with the 4-round TB screenings in the period of the first four post-entry years; pre-entry screenings by an initial chest X-ray (CXR) were conducted during 2012-2015, and a friendly treatment policy was introduced in 2014.Methods TB data of migrants during 2012-2015 were obtained from the National TB Registry Database and analyzed.The incidences, clinical characteristics, and treatment outcomes were assessed to explore the impact of underlying interventions. ResultsDuring post-entry 0-4 years, the TB incidence rates among marriage-migrants ranged 11-90 per 100,000 person-years, with 60.8% bacteria-positive and 28.2% smearpositive cases.Whereas among labor migrants, the incidence rates ranged 67-120 per 100,000 person-years, with 43.6% bacteria-positive and 13.7% smear-positive cases.All migrants originated from Southeast Asia following pre-entry health screening in 2012-2015.The TB cases among marriage-migrants were with a higher proportion of sputum-smear-positivity (SS+) (OR: 4.82, 95% CI: 3.7-6.34)and CXR cavitation (OR: 2.90, 95% CI: 2.10-4.01).Marriage-migrants with TB had treatment completion rate of > 90%, which was above the WHO target.For labor-migrants with TB, when compared the period of post-vs.pre-implementation of the friendly therapy policy that eliminated compulsory repatriation, the overall treatment completion rate of those who stayed in Taiwan improved by 30.9% (95% CI: 24.3-37.6)versus 6.7% (95% CI: 3.8-9.7),which exceeded a 4.88-fold (95% CI: 3.83-6.22)improvement.Additionally, the treatment initiation rate within 30 days of diagnosis for SS-TB and B-TB cases during post-vs.pre-implementation of the therapy policy was increased, i.e., 77.1% vs. 70.9%(OR: 1.38, 95% CI: 1.12-1.70)and 78% vs. 77% (OR:1.64,95% CI 1.38-1.95).Conclusion Multiple CXR screenings could identify more TB cases with sputum-smear-negativity (SS-) TB at the early-stage,