Minnesota Refugee Screening Protocol

1. Minnesota Refugee Screening Protocol Refugee and International Health Unit Cross-Cutting Epidemiology, Programs and Partnerships Section Infectious Disease, Epidemiology and Prevention Division Minnesota Department of Health

2. Outline of Recommended Exam Components • Health History • Immunization review and update • Screen for: • Tuberculosis • Hepatitis B • Intestinal Parasites • Lead poisoning (6 months - 16 years) • HIV and Syphilis • Evaluate for other STI • Assess for malaria risk • Screen per provider discretion • Physical Exam • Assessment for Dental, Vision, Mental Health • Treat, Refer or Initiate primary care

3. Recommended Exam Components • Use national guidance provided by CDC • www.cdc.gov/ncidod/dq/refugee/rh_guide/index.htm • Questions about national guidelines: • 24 Hours/Every Day • 800-CDC-INFO (800-232-4636) • cdcinfo@cdc.gov • Minnesota Refugee Provider Guide • www.health.state.mn.us/divs/idepc/refugee/guide/index.html

4. Exam Process / Scheduling To increase compliance with screening…. • Schedule refugees as a family unit • Schedule a trained medical interpreter for all visits or use Language Line • Arrange transportation to clinic if needed • Make reminder calls for each clinic visit

5. Exam Process/Scheduling cont. To increase compliance and return visit: • If unable to locate/contact family, work with Resettlement agency (VOLAG) case manager to find refugee • Use 2 or 3-visit model • Many clinics have moved toward 2 visits • See example workflows for the 2 or 3-visit models in the following slides:

6. Example of workflow for Three (3) clinic visits refugee health screening

7. 3rd Visit: Provider Exam 2nd Pre-Screening Nurse Visit 1st Pre-Screening Nurse Visit • Read TST • Obtain PA and Left Lateral CXR for all with positive TSTs/QFR • Obtain Labs (see assessment form for complete list, including CBC with differential for absolute eosinophil count; may be done on first visit if preferred) • Collect stool containers for O&P (if applicable) • Hearing and vision check • Schedule refugee 3rd visit / provider exam in 1-2 weeks when all lab results are available • Review test and lab results and treat based on findings • Administer presumptive therapy for malaria for refugees from sub-Saharan Africa, if indicated • Immunize • Growth and Development Screening • Mental Health Screening • Perform physical exam, include vision, hearing, cursory dental assessment • Make referrals if needed (hearing, vision, dental, family planning, WIC, pediatrics, other specialties) • Medical histories • Check for documentation of pre-departure treatment of malaria and parasitic infection • Screen for acute medical or social issues • Plot children on growth charts • Collect urinalysis • Urine pregnancy test (females 13 -45) • Serologic testing for strongyloides and/or schistosoma or give stool containers with direction for collection • Administer Tuberculin Skin Test (TST) or drawIGRA • Schedule return appointment in 2 to 3 days

8. Example of workflow for Two (2) clinic visits refugee health screening (NOTE: If patient has TST placed or stool sample due, a third visit may be required depending on scheduling)

9. 2nd Visit: Provider Exam 1st Pre-Screening Nurse Visit • Review test and lab results and treat based on findings • Administer presumptive therapy for malaria for refugees from sub-Saharan Africa, if indicated • Immunize • Growth and Development Screening • Mental Health Screening • Perform physical exam, include vision, hearing, cursory dental assessment • Make referrals if needed (hearing, vision, dental, family planning, WIC, pediatrics, other specialties) • Obtain PA and Left Lateral CXR for all with positive TSTs/QFR • Medical histories • Check for documentation of pre-departure treatment of malaria and parasitic infection • Screen for acute medical or social issues • Plot children on growth charts • Collect urinalysis • Urine pregnancy test (females 13 -45) • Serologic testing for strongyloides and/or schistosoma or give stool containers with direction for collection. If stool sample is required, refugee will need to drop off at clinic for testing before provider exam. • Administer Tuberculin Skin Test (TST) or drawIGRA • Obtain Labs (see assessment form for complete list, including CBC with differential for absolute eosinophil count) • Hearing and vision check • Schedule return appointment in 1-2 weeks. If TST is placed, refugee will need to come in for a read-only visit in 2-3 days.

10. Minnesota Refugee Health Program Phone: 651-201-5414 or 1-877-676-5414 Website:www.health.state.mn.us/refugee Address: Minnesota Department of Health Refugee Health Program Freeman Building 625 N. Robert Street P.O. Box 64975 St. Paul, MN 55164-0975