Nunavut’s Taima TB project helped more people get TB treatment: report
“The direct involvement of the community was central”
The best way to tackle Nunavut’s sky-high tuberculosis rate is to visit people at home, hire Inuit to communicate with Inuit and get the community working together on a common goal, the head of Taima TB, Dr. Gonzalo Alvarez, told Nunatsiaq News following the release of an evaluation report on the two-and-a-half year public health project.
“The direct involvement of the community was central to getting this off the ground,” Alvarez said.
Alvarez, a respirologist at the Ottawa Hospital, directed the Taima TB project — in close co-operation with the Government of Nunavut and Nunavut Tunngavik Inc. — from January 2011 to September 2013.
Its goal was to try new ways of reaching people in Iqaluit who may carry the bug that causes TB and try new ways of making sure they receive good treatment and finish their lengthy courses of medication.
The program started soon after an alarming spike in freshly-reported TB infections in Nunavut between 2005 and 2010 — 44 per cent of them in Iqaluit, the focus of the project.
After the program ended last fall, Alvarez said, Taima TB had identified 42 people who are latent TB carriers — people who carry the TB microbe inside their bodies but have yet to get sick.
They also identified eight new active cases.
To reach more latent carriers, Taima TB kicked off with a public education campaign that featured a community feast at the Anglican parish hall, radio and television interviews, news conferences, a video contest and educational messages from doctors, nurses and others.
During that part of the project, from January 2011 to May 2012, the number of people who decided on their own to go to public health for TB testing doubled — from about 25 people a month to about 50.
But after the public education effort ended, those numbers fell back to about 25 a month.
“This suggests that a sustained effort is likely necessary,” Alvarez said.
In the second phase, project organizers hired Inuktitut-speaking “TB Champions” and started a door-to-door campaign in selected high risk areas.
“That’s one example of how we integrated Inuit into the campaign,” Alvarez said.
Because they didn’t have enough money or people to screen everyone in Iqaluit for TB, the Taima TB team picked six residential areas in Iqaluit where people are believed to be at higher risk of contracting TB.
To choose those locations, they made a Google Map overlay using historic infection rate data to find neighbourhoods with the highest infection rates.
Because of the stigma surrounding TB, researchers did not identify those areas in their report.
A nurse and a TB Champion visited 614 households in the six areas. Of the 389 households where someone was at home, 214 agreed to be part of the project — and 422 people agreed to be tested.
About 176 of those people were ruled out because they have already been treated for the disease.
Of the 246 who did get tested, 18.8 per cent — about one in five — were diagnosed with latent tuberculosis.
Alvarez said he believes the key to reducing TB infections is to catch those latent cases before they become active and persuade people to complete the nine-month course of antibiotic medication required to eliminate the TB bug from their bodies.
That’s because people with latent TB don’t infect others.
And if latent TB carriers can be cured before they get sick with the disease and are capable of infecting others, TB can be stopped in its tracks, Alvarez said.
But that’s only half the battle. Encouraging people to take the required medication for latent TB — a drug called Isoniazid — twice a week for nine months can be a tough job.
To that end, people in the Taima TB program who were offered treatment could choose to have the medication delivered to their home, work or school.
About 61 per cent agreed to take the medication and of those, 68 per cent finished the full nine months, Alvarez said.
In a separate batch of patients receiving treatment from Iqaluit public health, about 70 per cent finished their treatment.
In all, Taima TB reported a 33 per cent increase in the number of people in Iqaluit who completed treatment for TB within the community.
During the infamous TB epidemic of the 1950s and early 1960s, the incidence rate in Nunavut exceeded 1,000 per 100,000.
Over the next 40 years, the disease went into a rapid decline, due to aggressive public health efforts.
But over the last decade, TB has bounced back with a vengeance.
In Nunavut, health workers diagnosed 101 active cases of TB in 2010. And Nunavut’s TB infection rate that year stood at 304 per 100,000.
That’s 62 times greater than the rate for all of Canada, which stood at 4.8 per 100,000 in 2012. Among First Nations communities, the rate is 22.2 per 100,000.
Alvarez said his team received funding for four more TB studies in Nunavut and will present more research results in the fall.