Nunavut tb control and elimination manual

Left untreated, latent TB can develop into active TB. Active TB can be fatal without treatment. For most people in Canada, the risk of developing active TB is very low. However, the rates of active TB are higher among Indigenous peoples, and they are particularly high in some Inuit communities.

The reported rate of active TB among Inuit in Inuit Nunangat was over times the rate of Canadian-born non-Indigenous people in This high rate is rooted in multiple factors, including inadequate housing, food insecurity, poverty, stigma, and the enduring impacts of government-led TB control measures during the s and s that transported many Inuit south by ship to TB hospitals thousands of kilometers away from their families and communities.

Those who survived did not return home for several years. In some situations, the fate of those who did not return remains unknown. In , there were approximately 65, Inuit living in Canada. Almost three quarters Although there are some significant differences in health status throughout Inuit Nunangat, there are also some common themes across the four regions.

According to Statistics Canada, life expectancy for Inuit is The Government of Canada is committed to working collaboratively with provincial and territorial partners and Indigenous leaders to address health and socio-economic factors contributing to the high incidence of active TB. In , Inuit Tapiriit Kanatami ITK developed the Inuit-specific Tuberculosis Strategy to increase awareness of the need for more effective approaches to TB prevention, control and care, and to present a path forward for reducing the rate of active TB in Inuit Nunangat.

To streamline coordination of this elimination work, efforts have continued through the Inuit Public Health Task Group; a subcommittee of the National Inuit Committee on Health NICoH , which is a forum that has been in place for many years representing Inuit organizations and public governments. The framework will be used to inform the development of regionally-specific tuberculosis elimination action plans by the four Inuit regions.

These action plans, anticipated to be finalized and initiated by late March , will outline concrete steps, such as strengthening community-based capacity to increase awareness and understanding of TB, reducing stigma, and enabling earlier diagnosis and treatment of active TB disease and latent TB infection. Work is currently underway in each of the four Inuit regions to develop regionally-specific TB elimination action plans.

Iqaluit can only be accessed by plane and ship during the brief summer and by plane only during the winter months. A TB awareness and prevention campaign was designed and carried out by the investigators in Iqaluit, Nunavut between January 13, and February 28, The study had three phases. In phase 1, the community at large was engaged with a general TB awareness campaign to provide community members with knowledge about TB, taking into account aspects of the regional culture, language, and TB history.

In phase 2, residential areas at high risk for TB within Iqaluit were identified and a door-to-door campaign offering in-home education and screening for TB was undertaken. In phase 3, home treatment was offered when indicated. Phase 1 January to May, focused on increasing TB awareness and knowledge by engaging the community at large.

Community involvement occurred at all levels including the introduction, design, implementation and delivery of the program. Precise translation of the facts into Inuktitut was undertaken because of the number of people who speak Inuktitut in Iqaluit. The TB facts were then tested in a community focus group. The videos were then screened at a community feast celebration event where the study and the team members were introduced to the community.

Various media events, including a press conference, radio and TV interviews were added to raise community awareness about TB. Phase 2 June to November was a door-to-door awareness, screening and testing campaign in residential areas that had shown historically high incidence of TB in Iqaluit.

Screening of all households in Iqaluit was not feasible. Using public health records, the primary residence of all incident cases of active TB disease during the previous five years was overlaid on a Google maps satellite image of the city. Six residential areas were delineated in this fashion. Commercial buildings were excluded. All forms of residential dwellings were considered including apartment buildings and structures housing single or multiple dwellings. All dwellings in these areas were visited via door-to-door screening by a research team consisting of a TB champion and a TB nurse.

Three TB champions and three public health nurses were hired for the study. The team did door-to-door screening during working hours, Monday to Friday. The videos and TB messaging were then put on a disc to be used as a vehicle to support the oral Inuit tradition for the sharing of information. The videos produced by community members in phase 1 using the five TB facts generated by the community health care staff and lay people were presented in their language of choice English or Inuktitut in each household visit using a portable DVD player.

This format allowed messaging to be delivered in a standardized and reproducible manner. If either test was positive, then patients were seen in the local clinic and underwent a physician-directed history, physical exam, chest radiograph, and sputum analysis to rule out active TB.

Once active TB was ruled out, these patients were offered treatment for latent TB infection. Patients were offered home delivery of medications but could choose another location ex. Treatment assessment was done by local TB doctors. The impact of the phase 1 awareness campaign on the community at large was determined by comparing the number of people who presented passively to the public health clinic before, during and after the general awareness campaign.

Ethnicity was determined by land claim beneficiary status. An adjusted logistic regression model was constructed using LTBI as the dependent variable adjusting for covariates: age, sex, smoking, alcohol use, cannabis use and diabetes. All patients provided written, informed consent. An increase in passive LTBI screening at the local Iqaluit public health clinic was observed during the Taima TB media engagement and general awareness campaign. In the four months that followed the general awareness campaign, the number of people who accessed the clinic returned back to an average 24 per month Figure 1.

In the fall of , there was an increase in passive screening that was directly attributable to an increase in TB awareness in the community related to a period of increased disease activity in the schools.

In of these dwellings, a resident answered the door. Five hundred and ninety individuals signed consent Table 1. The Taima door-to-door campaign yielded 42 new cases of previously undiagnosed latent TB.

During the six month period when the Taima program undertook the door-to-door campaign, there were a total of new positive TST diagnoses identified in Iqaluit all reasons for screening included.

During the same six month period the local TB program completed 34 new TST positive treatments and 33 during the same time period the year before. The resulting contact investigations by the local TB team identified another five active cases. Three additional active cases one Taima TB participant and two contacts were confirmed after the door-to-door campaign was complete.

All together eight cases six culture confirmed and two children treated as clinical cases of active TB disease were found directly or indirectly related to the study. The cases of LTBI found were extra cases that would not have been picked up by traditional screening practices. Furthermore, eight cases of active TB disease were detected in relation to the door-to-door campaign or It could be argued that an increase in active TB cases in the community would also result in an increase in people spontaneously walking in for testing even if they had not been identified as contacts.

However, during the study period, the number of diagnosed active cases actually decreased. The increase in walk-ins was short lived since once the general awareness campaign was completed the number of walk-ins returned back to the average before the campaign.

This finding underscores the need for sustained yearly TB awareness campaigns in the region. The participants who were screened for TB in residential areas of high risk for TB in Iqaluit were primarily young Inuit, many of whom had never been tested or had not been tested in the previous ten years.

This suggests the Taima TB program was able to reach out to people within this high risk group who were not being screened within the traditional local screening programs. Smoking tobacco increases the risk of acquisition of TB infection [19] , development of TB disease [20] , and is associated with increased TB mortality [21].

Because all the people within the GN department of Health normally tasked with managing TB are currently trying to manage the Covid pandemic. So unless you know where the GN can magically conjure up the two dozen or so extra health practitioners needed to respond to TB, I would suggest that complaining will accomplish very little. This makes no sense. The Minister of Health neeeds to explain. Yes, planning has been needed, but that should mostly have been done a long time ago.

Nunavut is the envey of the world. Please explain why we could not continue getting rid of TB. Why have we been unable to get rid of TB? I have to agree with you two, something is not right with this picture, maybe they lost focus and just stopped working on TB? Distracted maybe?