Nunavut’s new TB tester languishes in Iqaluit hospital

Dr. Gonzalo Alvarez explains how the Qikiqtani General Hospital’s new TB-tester works to federal Health Minister Leona Aglukkaq last March during a tour of the hospital’s laboratory. Bought by the Government of Nunavut, the new device’s testing was to be covered by a three-year $350,000 grant from the Canadian Health Research Institute. (FILE PHOTO))

A tool in Nunavut’s continuing war against tuberculosis remains underused in the Qikiqtani General Hospital.

Iqaluit’s hospital has a state-of-the-art diagnostic device, which can do an automated test for TB and evaluate antibiotic resistance to the infection in 90 minutes.

But the device isn’t being used regularly, said Elaine Randell, communicable disease consultant with the Government of Nunavut’s health and social services department.

The GN bought the “GenXpert” last year, with the federal and territorial health ministers, Leona Aglukkaq and Keith Peterson, both touting the machine as a life-saving timesaver.

That’s because the “GenXpert” eliminates the long waits and delays that occur when TB samples are sent to labs outside Nunavut, giving possibly infected people more chance to spread the disease — and get sicker.

The “GenXPert” has been helpful in research projects, Randell said, but TB culture smears are still sent out to laboratories in the South.

The time to hear back about those test results can take a few days or weeks depending on whether a person has active or dormant TB, she said.

So far in 2013, eight active cases of TB have been detected in Nunavut. But that tally “can change quickly,” Randell said.

In 2012, the total number of active TB cases in the territory reached 79.

People with TB symptoms, which include weight loss, chronic cough, night sweats or fever, can get a simple TB skin test at their health centre or at Iqaluit’s Public Health office.

But, when asked how many Nunavummiut get tested for TB, Randell said she didn’t have the numbers available because the health department has no capacity “to keep track of those numbers.”

Randell said she did not know how many walk-ins there are for TB tests at local health centres.

However, most skin tests that do come back positive are from dormant or “sleeping” TB, which people cannot spread, she said.

Active TB on the other hand is very contagious.

As for the success of two-year old Taima TB project to prevent and detect TB in Iqaluit, the GN is waiting for “summary results” on the project, she said.

However, the “Inuit-Specific Tuberculosis Strategy,” released March 25, says the project detected eight active TB cases in Iqaluit, “thus breaking the infectious cycle at an earlier point and and preventing further transmission in the community.”

Launched in April 2011 in Iqaluit around the motto “get tested before you get sick,” Taima TB (whose name roughly means “stop TB” in Inuktitut) aimed to improve screening for TB and treatment for people with active TB cases.

It also sought to reduce the overall number of TB cases in Iqaluit, which accounts for half of Nunavut’s annual TB cases, by using the Inuit language to talk about how to prevent the spread of the disease.

The strategy said Taima reached 440 people: two-thirds were screened for infection and about 100 were recommended for treatment because they tested positive.

The Taima program is carried out in Iqaluit only, though representatives from Taima visited Pangnirtung and Clyde River to conduct a youth outreach program.

But Randell did not have information on what the TB team did there or how the project went in those communities.

Randell said Nunavut follows the Canadian TB standard of prevention and treatment. That includes administering the Bacille Calmette-Guérin or BCG vaccine all newborns contact-tracing screening, and school screenings in grades six and nine.

For World TB Day, March 24, Nunavut’s health also sent out posters and other campaign materials to communities.

Nunavut’s TB rate remains 60 times higher than the national average, something that won’t change overnight, Randell said. But there is some good news – Nunavummiut have a “very low” drug resistance to medications used in TB treatment.

That means the territory doesn’t have the problem of the TB becoming drug-resistant which can happen if too many people stop taking medication during treatment or don’t follow up with treatment.

The highest number of cases of TB continue to be detected in the Baffin region.

Half of the active TB cases in Nunavut are among young people 15 to 34 years old, mainly from Iqaluit and Cape Dorset.

To tackle TB in communities with the largest number of cases, “we have brought in extra staff,” Randell said.