HIV/AIDS and associated conditions among HIV-infected refugees in Minnesota, 2000­2007.

In 2010, the requirement for human immunodeficiency virus (HIV) testing of adult refugees prior to US resettlement was removed, thus leading to a potential for missed diagnosis. We reviewed refugee health assessment data and medical charts to evaluate the health status of HIV-infected refugees who arrived in Minnesota during 2000-2007, prior to this 2010 policy change. Among 19,292 resettled adults, 174 were HIV-infected; 169 (97%) were African (median age 26.4 (range: 17-76) years). Charts were abstracted for 157 (124 (79%) with ≥ 1 year of follow-up). At initial presentation, two of 74 (3%) women were pregnant; 27% became pregnant during follow-up. HIV clinical stage varied (59%, asymptomatic; 11%, mild symptoms; 10%, advanced symptoms; 3%, severe symptoms; 17%, unknown); coinfections were common (51 tuberculosis, 13 hepatitis B, 13 parasites, four syphilis). Prior to arrival 4% had received antiretrovirals. Opportunistic infections were diagnosed among 13%; 2% died from AIDS-related causes. Arrival screening may be needed to identify these HIV-infected refugees and prevent HIV-related morbidity and mortality.

Health and healing: traditional medicine and the Karen experience.

OBJECTIVE: To examine the beliefs, attitudes and health-seeking behavior surrounding the use of traditional medicine among the Karen (refugees from Burma). METHODS: Three focus groups and two key-informant interviews were conducted with the Karen along with observations by researchers. RESULTS: The Karen continue to use elements of their traditional healthcare system after resettling in the U.S. Accessibility and perceived efficacy of treatments influence their health-seeking behavior. The participants discussed beliefs about health and healing, spirituality, and their experience as refugees. Implications for improving the quality of healthcare for the Karen and recommendations for further research are discussed.

Initial refugee health assessments. New recommendations for Minnesota.

Historically, the purpose of medical screening of new refugees has been to identify acute conditions such as infections that can be effectively addressed with short-term therapy. More recently, screening of refugees who are new to Minnesota has included identifying conditions that require ongoing care. But regular screening for chronic conditions only makes sense when follow-up care can be provided. To address this issue, the Minnesota Department of Health's Refugee Health Program, in conjunction with outside experts, reviewed its guidelines for medical screening of new refugees and revised its recommendations. In addition to recommending screening for infections and other acute conditions, the new guidelines call for screening for chronic conditions and repeat testing for diseases or conditions of long latency. The guidelines take into account the ability of the screening clinic to provide ongoing care or assure the patient's transition to primary care.

Caring for the Karen. A newly arrived refugee group.

Since 2004, Minnesota has seen an influx of refugees from Burma. Many of these newcomers came from the Karen state and spent time in refugee camps in Thailand before resettling in the United States. To better understand the health needs of this population, the authors of this article conducted chart reviews at a St. Paul family medicine clinic that serves a number of Karen refugees and reviewed formal data from the Minnesota Department of Health's Refugee Health Program. Here, they briefly describe this community, the cultural issues that could affect health care providers' ability to care for Karen patients, and the health concerns of these refugees.

Prevalence of hepatitis B surface antigen among refugees entering the United States between 2006 and 2008.

The Centers for Disease Control and Prevention recommends hepatitis B surface antigen (HBsAg) testing to identify chronic hepatitis B virus infection for foreign-born persons from countries or regions with HBsAg prevalence of >or=2%. However, limited data exist to indicate which countries meet this definition. To address this data gap, we estimated the HBsAg prevalence among refugees entering the United States between 2006 and 2008. We contacted state refugee health coordinators and asked them to report the number of refugees, country of origin, and HBsAg prevalence among refugees screened in their jurisdiction during the most recently available 12-month period prior to August 2008. We pooled data across jurisdictions and calculated the prevalence for any country with more than 30 refugees entering the United States, and where this level of data was not available by country, continents were considered. Of the 47 jurisdictions contacted, we received basic information from 31, with nine jurisdictions reporting HBsAg prevalence by country of origin applicable to 31,980 refugees (approximately 42% of refugees entering the United States during the observation period). We estimated an HBsAg prevalence of 2.8% (95% confidence interval 2.6%-3.0%) for refugees overall. Of the 37 countries with 30 or more refugees entering the United States, 25 had a prevalence of >or=2%. Prevalence was highest among refugees from Africa and Southeast Asia, and lowest among refugees from the Middle East and South/Central America. In the eight countries for which we had comparison data, six had lower HBsAg prevalence than in 1991.

Implementation of CDC refugee blood lead testing guidelines in Minnesota.

The state of Minnesota undertook a trial of the 2005 recommendations for blood lead testing in refugees developed by the Centers for Disease Control and Prevention. New refugee children younger than 16 years of age receiving health screening at an urban clinic were tested for elevated blood lead levels (EBLLs) and nutritional status. Follow-up lead tests were obtained three to six months after the first test. During the course of the project, 150 refugee children received an initial blood lead test and nutritional blood tests, and 140 (93%) received a second blood lead test. Five children (3.3%) had EBLLs at the initial blood lead test and one child (0.7%) had an EBLL at the second test after a nonelevated first test result. In contrast to findings from New Hampshire, this project did not observe a high number of refugees who developed EBLLs after moving to the U.S.

Prevalence of tuberculosis, hepatitis B virus, and intestinal parasitic infections among refugees to Minnesota.

OBJECTIVE: The purpose of this study was to define the prevalence of infection with Mycobacterium tuberculosis, hepatitis B virus, and various intestinal parasites among different groups of primary refugees immigrating to Minnesota. METHODS: 2,545 refugees arriving in Minnesota during 1999 received a domestic health examination that included tuberculin skin testing, hepatitis B virus serologic testing, and stool ova and parasite examinations. The Refugee Health Assessment form asked specifically about screening results for amebiasis, ascariasis, clonorchiasis, giardiasis, hookworm, schistosomiasis, strongyloidiasis, and trichuriasis. RESULTS: Forty-nine percent of refugees had a reactive tuberculin test of >or=10 mm induration, with a higher prevalence in males (54%) and refugees >or=18 years of age (63%) (p<0.001). Seven percent had a positive hepatitis B surface antigen, with the highest prevalence in those people from sub-Saharan Africa (8%) (p=0.002) and those refugees >or=18 years of age (9%) (p=0.006). Twenty-two percent had one or more intestinal parasites asked about, including 30% of those refugees <18 years of age (p<0.001). The most commonly reported parasitic infections were trichuriasis (8%) and giardiasis (7%). CONCLUSIONS: Evidence of infection with M. tuberculosis, hepatitis B virus, or one of eight intestinal parasites was present in a substantial proportion of refugees receiving the domestic health assessment. Screening for such infections gives new immigrants the opportunity to receive important medical evaluation and treatment, provides valuable surveillance data, and allows appropriate public health measures to be taken.