Grant: Operating Grant

In Canada and other high-income immigrant-receiving countries, a growing proportion of tuberculosis (TB) cases are foreign-born. This trend has led to a general consensus that TB control strategies in these countries must prioritize the screening and treatment for latent TB infection in foreign-born persons. In Canada, this strategy primarily occurs within the context of the Medical Surveillance Program and is restricted to persons identified as having inactive pulmonary TB or a history of TB during an immigration medical examination. Persons referred to Medical Surveillance account for approximately 15% of foreign-born TB cases and represent a high-risk group for active TB, the likelihood of TB being four to five times that of non-referred immigrants. Nevertheless, it is probable that some immigrants not eligible for Medical Surveillance have a risk of TB that is at least as high as some referrals. The purpose of this study is to determine if the inclusion criteria for the Citizenship and Immigration Canada (CIC) Medical Surveillance Program should be expanded to include other immigrant groups on the basis of an equal or greater risk for active TB as current referrals. Through ongoing partnerships with Health Canada and CIC, this aim will be achieved by linking and analyzing two national datasets. The first dataset consists of foreign-born TB cases diagnosed in Canada in 2003-2010 as per the Canadian TB Reporting System. The second dataset of all foreign-born persons (referrals and non-referrals) who arrived in Canada in 2003-2010 will be provided by CIC. As the first nation-wide study that defines and compares the risk of developing active TB among Medical Surveillance referrals and non-referrals, it is anticipated that the study results will inform an evidence-based redesign of the Medical Surveillance Program that optimizes the inclusion of immigrants at high risk for active TB and leads to fewer missed opportunities for preventing TB in the foreign-born.