Fighting tuberculosis in Canada's North with community-based approach

Posted on Thursday, July 17, 2014

While the incidence of tuberculosis remains low in Canada overall, it continues to be a significant public health concern in the North. Researchers at The Ottawa Hospital working with community partners have found a novel way to improve detection of the persistent and sometimes deadly respiratory disease in Canada's North. They published their findings online today in PLOS ONE.

Working in partnership with the Government of Nunavut and Nunavut Tunngavik Inc. (NTI), respirologist Dr. Gonzalo Alvarez conducted a study called Taima TB, addressing the problem of tuberculosis in Iqaluit, Nunavut. Taima means “stop” in Inuktitut. His team developed a targeted way of screening for tuberculosis and used it in combination with a public awareness campaign that involved the Inuit culture and community at every stage.

During the awareness campaign, which ran from January 2011 to September 2013, the number of people who were tested and treated for tuberculosis increased. Tuberculosis, an infectious disease that attacks the lungs and can lead to death if left untreated, typically causes shortness of breath, coughing, fever and night sweats. It can, however, be cured with the right treatment.

“This study shows the effectiveness of taking a strong campaign that combines awareness, testing and treatment directly to the areas of the community hardest hit by this disease,” says Dr. Alvarez, who regularly treats tuberculosis in isolated Arctic communities. “A critical component of this was the level of community involvement. Making these gains would have been impossible without this collaboration.”

Taima TB built on Inuit traditions for sharing information. It involved community gatherings, radio shows and a video contest. In addition, community members—called TB Champions—knocked on more than 600 doors to offer in-home screening and treatment for latent TB infection (a sleeping form of the disease). This process resulted from the fact that community members prefer receiving information directly from other Inuit, rather than from healthcare professionals.

“We developed a novel way of targeting our efforts by identifying areas of Iqaluit where cases are most likely to occur and multiply,” says Dr. Alvarez, an associate professor of medicine at the University of Ottawa and a scientist at the Ottawa Hospital Research Institute. “It was an efficient way to improve the rates of testing and treatment for TB.”

Approximately one in every five persons screened using this targeted screening approach was found to have a latent TB infection, a form of the disease that can lie dormant with no symptoms before turning into active TB. The method used in the study to identify high-risk areas also correctly predicted the area of residence of 82% of all of the cases of active TB that occurred during the study period. In addition, the number of patients who successfully completed treatment for latent TB infection during the study period increased by 33%.

Nunavut is the only jurisdiction in Canada where the incidence of tuberculosis is increasing. As recently as 2010, more than 100 Inuit in Nunavut were infected with tuberculosis, an infection rate 62 times the Canadian average. The high rates of TB prompted the Government of Canada to invest $805,000 in Dr. Alvarez's Taima TB study project through the Public Health Agency of Canada's National Lung Health Framework. CIHR has subsequently funded Dr. Alvarez to conduct related studies on TB in Canada's North.

During the community awareness campaign, the number of people in Iqaluit who decided to go to the public health department for testing doubled, going from an average of 25 people a month to 50. However, Dr. Alvarez found that the number of people requesting testing for tuberculosis in Iqaluit fell back once the community awareness phase of the project was completed, showing the need for a sustained public awareness campaign.

In 2012, there were 4.8 new cases of tuberculosis reported for every 100,000 people in Canada, a slight increase from previous years. However, among Canada`s aboriginal population, the number of new cases of tuberculosis reported in 2012 was six times higher, at 29.2 for every 100,000 people. In Nunavut, the spread of tuberculosis remains extremely high, with 234 new cases per 100,000 people reported in 2012.

Earlier this year, Ottawa and the World Health Organization each came out with new strategies to fight tuberculosis.

The full article, “TAIMA (Stop) TB: The impact of a multifaceted TB awareness and door-to-door campaign in residential areas of high risk for TB in Iqaluit, Nunavut,”was published today by PLOS ONE.

Partner Quotes:

“Our Government knows that tuberculosis is a real concern in the North and in Nunavut in particular. I have long been an advocate for taking action on TB and the Taima TB project in particular. These findings are an important step forward in finding ways to combat this deadly but curable disease. On behalf of the Government, I want to say thank you to Dr. Gonzalo Alvarez and his team for their important work on tuberculosis in Canada's North.”
–Leona Aglukkaq, MP for Nunavut

“One of the most important outcomes of the Taima TB research project was the partnerships that were formed by working together to stop the spread of TB. These will be a valuable asset to our multifaceted territorial TB Control Program as we continue to work with our communities to stop TB.”
–Monica Ell, Minister of Health, Nunavut

“Taima TB has truly been a participatory research project, focusing on a subject matter that is an Inuit priority. This makes the research meaningful on a number of levels. It has contributed significantly to our understanding of the elements required to build effective and meaningful public health interventions.”
–NTI President, Cathy Towtongie

"The Government of Canada is committed to helping reduce the rate of tuberculosis in Canada and supports the development of effective public health interventions and research. The innovative and strategic work of the Ottawa Hospital Research Institute and Dr. Alvarez is a compelling example of how working closely with provinces and territories while actively engaging the communities most at risk can help us deliver meaningful solutions in the fight against tuberculosis.”

–The Honourable Rona Ambrose, Minister of Health

Resources
Taima TB page from Nunavut Tunngavik Inc.
Taima TB YouTube channel

About the University of Ottawa
The University of Ottawa is committed to research excellence and encourages an interdisciplinary approach to knowledge creation, which attracts the best academic talent from across Canada and around the world.

About the Ottawa Hospital Research Institute
The Ottawa Hospital Research Institute is the research arm of The Ottawa Hospital and an affiliated institute of the University of Ottawa, closely associated with the University's faculties of Medicine and Health Sciences. The Ottawa Hospital Research Institute includes more than 1,700 scientists, clinical investigators, graduate students, postdoctoral fellows and staff conducting research to improve the understanding, prevention, diagnosis and treatment of human disease. Research at Ottawa Hospital Research Institute is supported by The Ottawa Hospital Foundation.

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