Research shows new TB tester reduces diagnosis time in Nunavut

Dr. Gonzalo Alvarez explains how the Qikiqtani General Hospital’s TB-tester works to Nunavut MP Leona Aglukkaq, then the federal health minister, in March 2012 during a tour of the hospital’s laboratory. (FILE PHOTO))

Tuberculosis, the focus of World TB Day, March 24, continues to be a significant public health concern in Canada’s North, where TB rates are sky-high and testing for TB takes far longer than in the country’s major centres.

“The battle is not won. We can see it in Iqaluit and Nunavut where the cases are still present,” Dr. Gonzalo Alvarez, a respirologist at the Ottawa Hospital, told Nunatsiaq News.

A paper published March 19 by Alvarez and other researchers in Iqaluit, Ottawa and Montreal in the Chest journal, shows that the time it takes to diagnose and begin treating this deadly infectious disease in Nunavut can be dramatically reduced by using a new technology — already in Iqaluit — that quickly provides accurate results.

The study showed that operating a DNA testing unit, called GeneXpert, in Iqaluit’s Qikiqtani General Hospital significantly sped up diagnosis of TB, especially for those with low levels of the bacteria in their sputum, the mucus that is coughed up from the lower airways of the lungs.

As a result, the average time to start treatment was reduced to 1.8 days, as opposed to 7.7 days for patients with high levels of TB bacteria and 37 days for those with low levels of the bacteria.

Alvarez said he’s “excited with the results” — not just because they’re accurate but because patients who start treatment begin to feel better immediately.

“It can make a big difference in a patient’s life.”

Cathy Towtongie, president of Nunavut Tunngavik Inc., agrees.

“With advancements such as this, we know that our painful history with TB has ended, and that we now can readily access better diagnosis and treatment. I hope to see this new technology become more widely available to Inuit in all Nunavut communities affected by TB,” said Towtongie in an Ottawa hospital news release on the new study.

Armed with the study’s results, the Government of Nunavut recently announced it wanted to spend more money in its 2015–2016 budget that will keep the GeneXpert operating in the territory’s capital.

“The research findings confirm that this new technology can provide a significantly earlier confirmation of active tuberculosis in our territory. Earlier diagnosis and treatment decreases the spread of TB and is an important step toward our ultimate goal of eliminating TB in Nunavut,” said Paul Okalik, Nunavut’s health minister, in the Ottawa release.

Alvarez told Nunatsiaq News that he’s happy to see the territorial government acting in a “proactive” way and using their research study’s results.

And he said he hopes the TB tester will also be used to test samples from possible TB sufferers outside Iqaluit.

The incidence of active TB in Nunavut remains the highest in Canada. In 2014, there were 83 residents of Nunavut treated for active TB.

Despite the high rate, there is no TB laboratory capacity in Nunavut. Samples are sent to Ottawa for testing.

That’s why, working in partnership with the GN and NTI, and with support from the Canadian Institutes of Health Research, Alvarez and Madhukar Pai from at the Research Institute of the McGill University Health Centre, tested the GeneXpert TB between 2012 and 2015.

GeneXpert is a desktop “lab-in-a-box” that identifies the presence of the TB bacteria’s genetic code.

Alvarez and Pai wanted to see whether the GeneXpert could provide accurate results to reduce wait times before starting treatment and to minimize the continued spread of the disease.

To do that, they designed a study that would test this technology in action, with GeneXpert unit operating as part of the community’s hospital laboratory and cutting the start of treatment to a little more than a day.

“It’s cases like this, and in remote settings with no on-site TB testing capacity, where GeneXpert can make the greatest difference,” said Pai in the release.