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

Abstract

BackgroundThe incidence rate of active tuberculosis (TB) disease in the Canadian Territory of Nunavut has shown a rising trend over the past 10 years. In 2010 it was 60 times greater than the national incidence rate. The objective of the Taima (translates to “stop” in Inuktitut) TB study was to implement and evaluate a public health campaign to enhance existing TB prevention efforts in Nunavut.MethodsA TB awareness campaign followed by a door-to-door screening campaign was carried out in Iqaluit, Nunavut. The aim of the campaign was to raise awareness about TB, and to provide in-home screening and treatment for people living in residential areas at high risk for TB. Screening was based on geographic location rather than on individual risk factors.ResultsDuring the general awareness campaign an increase in the number of people who requested TB testing at the local public health clinic was observed. However, this increase was not sustained following cessation of the awareness campaign. Targeted TB screening in high risk residential areas in Iqaluit resulted in 224 individuals having TSTs read, and detection of 42 previously unidentified cases of latent TB, (overall yield of 18.8% or number needed to screen = 5.3). These cases of latent TB infection (LTBI) were extra cases that had not been picked up by traditional screening practices (34% relative increase within the community). This resulted in a 33% relative increase in the completion of LTBI treatment within the community. The program directly and indirectly identified 5/17 new cases of active TB disease in Iqaluit during the study period (29.5% of all incident cases).ConclusionsWhile contact tracing investigations remain a cornerstone of TB prevention, additional awareness, screening, and treatment programs like Taima TB may contribute to the successful control of TB in Aboriginal communities.

Stochastic agent-based modeling of tuberculosis in Canadian Indigenous communities

“…Public health awareness campaigns have demonstrated success in increasing TB testing rates within Iqaluit, the capital of Nunavut. However, this level of testing was not sustained after the completion of the awareness campaigns [5]. The First Nations and Inuit Health Branch (FNIHB) of the Government of Canada set a goal of reducing TB in the Inuit population of Canada to 3.6 cases per 100,000 population by 2015 [2].…”

“…The First Nations and Inuit Health Branch (FNIHB) of the Government of Canada set a goal of reducing TB in the Inuit population of Canada to 3.6 cases per 100,000 population by 2015 [2]. Recent data indicate that this goal has not been met, suggesting that additional public health strategies in addition to routine contact tracing and screening are necessary to address TB in Nunavut [5]. …”

Social determinants of health among residential areas with a high tuberculosis incidence in a remote Inuit community

“…Our team visited 162 dwellings located within the high-risk neighbourhoods, where 590 participants provided consent for review of medical records and first home visit13 (see online supplemental appendix). Of the 590 participants who provided consent, 146 were excluded due to loss to follow-up, declining participation in the Taima TB study or moving after being contacted.…”

“…Our questionnaire was part of a larger study (Taima TB)13 offering door-to-door screening and treatment for TB in high TB burden zones in Iqaluit. The questionnaire was offered in English and Inuktitut.…”

“…High-risk residential areas were defined as more than five active TB cases in the previous 4 years, and the areas were determined using addresses of the active TB cases and Google maps. Four high-risk residential areas were identified, from which our data were collected 13. The premise of the Taima TB study was to offer screening to all eligible individuals based on residence in an identified high-risk geographical area and not individual risk factors for TB.…”