Improving the detection of infectious diseases in at-risk migrants with an innovative integrated multi-infection screening digital decision support tool (IS-MiHealth) in primary care: A pilot cluster-randomized controlled trial

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The study was funded by the Catalonian government (PERIS 2017 SLT002/16/0045).

Analysis of institutional authors

Requena Mendez, Maria Del PilarAuthorSerra, BertaAuthorSequeira-Aymar EAuthorRequena-Méndez ACorresponding Author

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Article

Publicated to:Journal Of Travel Medicine. 29 (7): taab100- - 2022-11-04 29(7), DOI: 10.1093/jtm/taab100

Authors: Sequeira-Aymar, Ethel; Cruz, Angeline; Serra-Burriel, Miquel; di Lollo, Ximena; Queiroga Goncalves, Alessandra; Camps-Vila, Laura; Monclus-Gonzalez, Marta M; Revuelta-Munoz, Elisa M; Busquet-Sole, Nuria; Sarriegui-Dominguez, Susana; Casellas, Aina; Dalmau Llorca, Maria Rosa; Aguilar-Martin, Carina; Jacques-Avino, Constanza; Hargreaves, Sally; Requena-Mendez, Ana

Affiliations

August Pi i Sunyer Biomed Res Inst IDIBAPS, Barcelona, Spain - Author

August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Carrer Rosselló, 149, Barcelona, Spain. - Author

Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona). Carrer Rosello 132, 40, 08036 Barcelona, Spain. - Author

Centre d'Atencio Primaria 1 Maig, Institut Català de la Salut (ICS), Carrer De la Mercè, 5, 25003, Lleida, Spain. - Author

Centre d'Atencio Primaria Plaça Catalunya, Institut Català de la Salut (ICS), Carrer Soler i March, 6, 08242 Manresa, Spain. - Author

Centre d'Atencio Primaria Rambla Ferran, Institut Català de la Salut (ICS), Carrer Rambla Ferran 44, 25007, Lleida, Spain. - Author

Centre d'Atencio Primaria Sagrada Família, Consorci Sanitari Integral (CSI), Carrer Còrsega 643, 08025 Barcelona, Spain. - Author

Centre d'Atencio Primaria Sagrada Família, Institut Català de la Salut, Carrer St. Cristòfol, 34, 08243 Manresa, Barcelona, Spain. - Author

Consorci Atencio Primaria Salut Barcelona Esquerr, Barcelona, Spain - Author

Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE) Casanova, Carrer Rosselló 161, 08036 Barcelona, Spain. - Author

Consorci Sanitari Integral CSI, Ctr Atencio Primaria Sagrada Familia, Barcelona, Spain - Author

Department of Medicine Solna, Karolinska Institutet, Solnavägen 17177, Solna (Stockholm), Sweden. - Author

Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Rämistrasse 71, 8006 Zürich, Switzerland. - Author

Equip d'Atenció Primària Tortosa Est, Institut Català de la Salut, Avenida Generalitat 95, 43500, Tortosa, Tarragona, Spain. - Author

Fundacio Inst Univ Recerca Atencio Primaria Salu, Barcelona, Spain - Author

Fundacio Inst Univ Recerca Atencio Primaria Salut, Unitat Suport Recerca Terres Ebre, Tarragona, Spain - Author

Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain. - Author

Inst Catala Salut ICS, Ctr Atencio Primaria Maig 1, Lleida, Spain - Author

Inst Catala Salut ICS, Ctr Atencio Primaria Placa Catalunya, Manresa, Spain - Author

Inst Catala Salut ICS, Ctr Atencio Primaria Rambla Ferran, Lleida, Spain - Author

Inst Catala Salut, Ctr Atencio Primaria Sagrada Familia, Barcelona, Spain - Author

Inst Catala Salut, Equip Atencio Primaria Tortosa Est, Tarragona, Spain - Author

Inst Catala Salut, Unitat Avaluacio, Direccio Atencio Primaria Terres Ebre, Tarragona, Spain - Author

Inst Catala Salut, Unitat Docent Med Familia & Comunitaria Tortosa T, Tarragona, Spain - Author

Karolinska Inst, Dept Med Solna, Stockholm, Sweden - Author

Migrant Health Research Group, Institute for Infection and Immunity, St. George's, University of London, London, SW17 0RE London, United Kingdom. - Author

St Georges Univ London, Inst Infect & Immun, Migrant Hlth Res Grp, London, England - Author

T1.01 - Recerca transversal en atenció primària. Institut d'Investigacions Biomèdiques August Pi i Sunyer - Author

Unitat d'Avaluació, Direcció d'Atenció Primària Terres de l'Ebre, Institut Català de la Salut, Tortosa, 43500 Tarragona, Spain. - Author

Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Tarragona, Spain. - Author

Unitat Docent de Medicina de Família i Comunitària Tortosa-Terres de L'Ebre, Institut Català de la Salut, 43500 Tortosa, Tarragona, Spain. - Author

Univ Autonoma Barcelona, Barcelona, Spain - Author

Univ Barcelona, Barcelona Inst Global Hlth ISGlobal, Hosp Clin, Barcelona, Spain - Author

Univ Zurich, Epidemiol Biostat & Prevent Inst, Zurich, Switzerland - Author

Universitat Autònoma de Barcelona, Bellaterra, 08193 Cerdanyola del Vallès (Barcelona), Spain. - Author

Abstract

There are major shortfalls in the identification and screening of at-risk migrant groups. This study aims to evaluate the effectiveness of a new digital tool (IS-MiHealth) integrated into the electronic patient record system of primary care centres in detecting prevalent migrant infections. IS-MiHealth provides targeted recommendations to health professionals for screening multiple infections, including HIV, hepatitis B and C, active tuberculosis, Chagas disease, strongyloidiasis, and schistosomiasis, based on patient characteristics (including variables of country of origin, age, sex).A pragmatic pilot cluster-randomised controlled trial was deployed from March to December 2018. Eight primary care centres in Catalonia, Spain, were randomly allocated 1:1 to use of the digital tool for screening, or to routine care. The primary outcome was the monthly diagnostic yield of all aggregated infections. Intervention and control sites were compared before and after implementation with respect to their monthly diagnostic yield using regression models. This study is registered on ISRCTN (ISRCTN14795012).15780 migrants registered across the 8 centres had at least one visit during the intervention period (March to December 2018), of which 14 598 (92.51%) fulfilled the criteria to be screened for at least one infection. There were 210 (2.57%) individuals from the intervention group with new diagnoses compared with 113 (1.49%) from the control group (OR:2.08 95%CI 1.63-2.64, p < 0.001). The intervention centres raised their overall monthly diagnosis rate to 5.80 (95%CI 1.23-10.38, p = 0.013) extra diagnoses compared to the control centres. This monthly increase in diagnosis in intervention centres was also observed if we consider all cases together of HIV, hepatitis B and C, and active TB cases (2.72,[95%CI 0.43-5.00]; p = 0.02) and was observed as well for the parasitic infections´ group (Chagas disease, strongyloidiasis, and schistosomiasis) 2.58 (95%CI 1.60-3.57; p < 0.001).The IS-MiHealth increased screening rate and diagnostic yield for key infections in migrants in a population-based primary care setting. Further testing and development of this new tool is warranted in larger trials and in other countries.© International Society of Travel Medicine 2021. Published by Oxford University Press.

Keywords

migrationmodelChagas diseaseClinical decision support systemControlled studyHealthHepatitis bHiv infectionsHumanHuman immunodeficiency virus infectionHumansInfectious diseaseMigrantMigrationPrimary health careProceduresRandomized controlled trialScreeningSoftwareStrongyloidiasisTransients and migrantsTuberculosis

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Journal Of Travel Medicine due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2022, it was in position 5/207, thus managing to position itself as a Q1 (Primer Cuartil), in the category Public, Environmental & Occupational Health. Notably, the journal is positioned above the 90th percentile.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 4.75. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

Weighted Average of Normalized Impact by the Scopus agency: 3.88 (source consulted: FECYT Feb 2024)
Field Citation Ratio (FCR) from Dimensions: 10.32 (source consulted: Dimensions May 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-05-02, the following number of citations:

WoS: 21
Scopus: 19
Europe PMC: 6
OpenCitations: 8

Impact and social visibility

Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Sweden; Switzerland; United Kingdom.

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: First Author (Sequeira Aymar, Ethel ) and Last Author (Requena Mendez, Ana).