'Tuberculosis champions' in Nunavut improve testing, treatment

Researchers say they've found a unique way to detect hidden cases of tuberculosis in Canada's North, where the bacterial infection is still a major public health problem.

'People welcomed us into their homes,' to hear about TB in their own language, nurse says

Respirologist Dr. Gonzalo Alvarez and his team developed a targeted way of screening for tuberculosis and used this in combination with a public awareness campaign that involved the Inuit culture and community at every stage. (Ottawa Hospital Research Institute)

Researchers say they've found a unique way to detect hidden cases of tuberculosis in Canada's North, where the bacterial infection is still an important public health problem.    

The rate of TB infections in Nunavut is 62 times the Canadian average, in part due to crowded housing conditions, poor nutrition and high smoking rates. TB primarily attacks the lungs and can be deadly without treatment.

Dr. Gonzalo Alvarez, a respirologist and scientist with the Ottawa Hospital Research Institute, used information about previous TB cases to target high-risk neighbourhoods in Iqaluit. The usual method of tracking the infection is to follow up with contacts of known cases.

Alvarez, and local community members and health officials then developed an awareness campaign, translating TB information into Inuktitut, the Inuit language, and producing videos that were shown at a community gathering.

"The central feature to this was community involvement," said Alvarez, adding that the awareness campaign alone led to a doubling of the number of people in Iqaluit requesting TB testing.

Researchers gave a progress report on the TB campaign to the Nunavut community, and some of the info presented said there was an increase in the number of people who went on treatment. (Ottawa Hospital Research Institute)

But he said the next part of the project had an even larger impact.

"We actually hired TB champions, which are people from the community who speak Inuktitut and we were able to train them on the facts about TB."

Those champions then teamed up with public health nurses and went door to door in the targeted areas, showing the videos and offering in-home TB testing.

"People welcomed us into their homes," said team nurse Naomi Davies. "They were happy to hear about TB in their own language. People were able to relate to the materials."

Alvarez says 246 people were tested for TB.

"We found a case of latent TB infection for every five we screened," a total of 42 cases, he said.

People infected with latent or inactive TB don’t have symptoms and aren’t infectious but can go on to develop the disease, so are treated with antibiotics to prevent the bacteria from becoming active. The testing identified another eight cases of active TB.

Alvarez said it’s clear that reaching out to the community had a big impact beyond existing public health programs.

"We increased the number of people who went on treatment and completed treatment by about 33 or 34 per cent."

Noah Papatsie, a city counsellor in Iqaluit, discovered he had TB when he was being treated for injuries after an accident in 2000. He has become an advocate for testing and a supporter of the project.

"It's very important to get yourself tested," he said. "I didn't know I had TB and apparently it was some of my coworkers who had it and it passed on to me."

The results of the project were published Thursday in the online medical journal PLOS ONE.

Alvarez says that since the study ended 10 months ago, the rates of testing have fallen back.

"Really what that teaches me is you need to keep your foot on the gas. That kind of awareness needs to happen on a yearly basis," he said.

Alvarez now hopes to replicate the success.

He has received funding from the Canadian Institutes of Health Research (CIHR) to run the Inuit-friendly awareness campaign in four additional communities in Nunavut.