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

Background Tuberculosis (TB) remains a major public health challenge, particularly among migrants, who face increased vulnerabilities due to social and structural barriers. A syndemic framework provides a comprehensive approach to understanding how these intersecting vulnerabilities shape TB outcomes and inform public health interventions. In Catalonia, the Model of Community and Public Action (MACIP) programme, implemented with Community Health Workers (CHWs), improves TB case management and healthcare access through culturally adapted, community-based strategies. The study aims to describe the vulnerability determinants among migrants diagnosed with TB in Catalonia who were enrolled in MACIP through a syndemic approach and to use these insights to propose a novel syndemic framework for TB control in migrant communities. Methods A descriptive study was conducted among migrant TB patients enrolled in the MACIP in Catalonia in 2023. Clinical, sociodemographic, and migration-related determinants, along with community-based interventions, were collected from CHW-led interventions, the Epidemiological Registry of Catalonia, and the Central Registry of Insured Individuals of Catalonia. Descriptive statistics were performed via RStudio. The findings were used to design a proposal for a syndemic framework for TB control in migrant communities. Results Among 121 migrant TB patients, most were men (67.8%) from the Eastern Mediterranean (35.5%) and Southeast Asia (33.1%) regions. A majority (87.6%) had low or very low socioeconomic status, and 23.1% lacked a healthcare identification card at diagnosis. The median diagnostic delay was 49 days [IQR 26–89]. The main reasons for MACIP referrals were language and cultural barriers (66.1%) and contact tracing difficulties (54.5%). Community-based interventions, particularly phone calls (48.3%) and WhatsApp messaging (34.6%), played a key role in improving engagement, with an average of 21.2 actions per participant. A conceptual syndemic framework was developed based on three domains: (1) biological and behavioural (age, sex, and comorbidities); (2) migration-related (country of origin, years since arrival, motivation of migration, imprisonment, legal status, and healthcare access); and (3) structural (socioeconomic status, employment, education, and housing conditions). Conclusions A syndemic approach enhances the understanding of vulnerability determinants and informs the design of culturally adapted, community-based interventions. The proposed framework integrates social and structural determinants into TB control strategies, aiming to improve healthcare access, equity, and case management among migrant communities.