Grant: Project Grant

Canada has pledged to support the elimination of tuberculosis (TB). Yet, the incidence of TB disease in Canada has remained unchanged for the last decade. Most TB disease in Canada is caused by progression of dormant TB infection, a completely asymptomatic condition, acquired prior to migration in persons born outside of Canada. Treatments for dormant infection reduce the risk of developing TB disease by 90%. However, despite the World Health Organization and the Canadian Tuberculosis Standards recommending expanded treatment of dormant infection, few persons are treated. In part, this is due to substantial uncertainty about which populations are most likely to benefit from treatment of dormant infection, and the size and costs of programs necessary to test and treat dormant infection. This proposal uses a population database in British Columbia to identify which persons would benefit from testing and treatment of dormant infection and develops and costs different strategies to ensure persons with dormant infection receive treatment. Specifically, we will: 1. Identify the specific populations, based on age, sex, medical risk factors, and time since immigration, expected to benefit from treatment of dormant infection. 2. Estimate how many additional people will require treatment of dormant infection in British Columbia if all those expected to benefit from treatment receive it. 3. Estimate the costs and potential health impacts of expanding treatment of dormant infection, with input of provincial and federal stakeholders. This work addresses a global knowledge gap by identifying which populations are most likely to benefit from treatment of dormant infection. It will provide information to decision makers, like public health authorities, on the benefits and cost of programs to test and treat dormant TB infection, supporting efforts to eliminate TB. Findings will be relevant to other countries seeking to expand programs to test and treat dormant TB infection.