Community-based strategies for tuberculosis control in migrant communities: how to integrate determinants of vulnerability into decision-making

Tuberculosis (TB) remains a major public health challenge, particularly among migrant populations, who face increased vulnerability due to social and structural determinants of health. In Catalonia, Spain, the Model of Community and Public Action (MACIP) programme was launched in 2023 to improve TB prevention and care through culturally adapted, community-based interventions delivered by community health workers (CHWs). This study aims to describe the vulnerability determinants among migrants diagnosed with TB and enrolled in the MACIP programme, and to present the community-based strategies implemented. The analysis was informed by a conceptual framework based on the social determinants of health, aimed at supporting people-centred, equity-oriented TB control and informing decision-making. A descriptive study was conducted among migrant TB patients included in the MACIP programme between January and December 2023. Sociodemographic, clinical, and migration-related variables were collected from the Epidemiological Registry of Catalonia, the Central Registry of Insured Individuals of Catalonia, and the digital data collection system used by CHWs. Vulnerability indicators and community-based interventions were analysed using descriptive statistics. Comparisons between regions of origin were performed using Chi-squared or Fisher’s exact tests for categorical variables and the Kruskal–Wallis test for continuous variables. Community-based interventions were implemented for 121 migrant patients. Most were men (67.8%) and originated from the Eastern Mediterranean (35.5%) and Southeast Asia (33.1%) regions. A high proportion (87.6%) had low or very low socioeconomic status, and 23.1% lacked a healthcare identification card at diagnosis. The median diagnostic delay among symptomatic pulmonary TB cases was 49 days [IQR 26–89]. The main reasons for referral to MACIP were language and cultural barriers (66.1%) and difficulties in contact identification and follow-up (54.5%). A total of 2.567 community-based activities were recorded. On average, 21.2 actions were carried out per participant. Social and migration-related determinants significantly shape TB vulnerability among migrant communities. Integrating these determinants into community-based strategies such as MACIP may enhance equity, strengthen case management, and improve treatment outcomes. This approach aligns with global efforts to address TB through people-centred, culturally adapted public health interventions.