Grant: Operating Grant

Tuberculosis (TB) remains one of the most important global public health problems. In 2012, Aboriginal people had a TB incidence rate 6 times higher than the Canadian average, a pattern which dates back 120 years. In Nunavut, the rate was 50-fold higher (234/100,000). In 2011-12, there was a severe outbreak in one Nunavik village: 10% of residents were diagnosed with active TB. TB rates in Nunavut exceed those in many developing countries. Smoking, heavy alcohol use, overcrowded housing, and diabetes are all strong risk factors for developing TB, with the first three very common in the North. There are several potential interventions to address these conditions in Nunavut and Nunavik. Reducing their frequency may substantially reduce TB disease. Using computer programs that simulate the spread of TB, we will predict the benefits and cost effectiveness of two potential ways to improve TB control in Inuit communities. The computer simulations will be based on past and current data about TB epidemiology as well tobacco and alcohol use, diabetes, and housing. The first way focuses on general health, and includes: i) smoking prevention/cessation, ii) reduction of heavy alcohol use, iii) diabetes prevention, iv) improved housing. The second, TB-specific way involves i) enhanced diagnosis and treatment of dormant TB infection ii) diagnosing people with active TB disease earlier in the course of illness iii) a new, rapid laboratory test for active TB which can be performed in the North. These allow preventive treatment and earlier diagnosis, potentially reducing mortality and transmission. We will compare predictions of active TB cases prevented, deaths prevented and quality-adjusted life years gained, and costs. The latter will include costs borne by patients and families. This research will help community members, health care providers and funders to choose the best approach to tackling the complex TB epidemics in Inuit communities.