Grant: Project Grant

Innovative work has led to critical insights for developing best practices for tuberculosis (TB) control. Specifically, these insights have led to improved prevention strategies in Canadian sub-populations that remain at high risk. Two important such groups are indigenous peoples and recent migrants where recurrent TB contributes to human suffering. Tools developed in the 1990s, supported the use of molecular differentiation ("fingerprinting") of TB isolates. Molecular insights are critical to differentiating the two types of recurrence - relapse, a return of the previous inadequately treated disease, and reinfection which results from new infection resulting from an undiagnosed, infectious case in the community. The development of reliable tools to distinguish relapse from reinfection TB are a critical next step for public health programs. We propose to advance our knowledge respectful of Indigenous Ways of Knowing. Our team has national representation and is well positioned to support the necessary knowledge translation to make an important step forward in TB public health practice. We propose to perform Whole Genome Sequencing of TB specimens from Saskatchewan, Alberta, Ontario and Nunavut where two isolates of the bacteria are available from one individual separated by at least one year. Reinfection TB will be clearly quantified and a platform for laboratory management of reinfection TB will be developed. We will engage public health partners through an iKT approach through needs assessment, environmental scans, scoping reviews to develop a best practice guideline for managing reinfection TB. Our deliverables will include supporting TB control programs in remote Canada and producing guidelines for the next edition of the Canadian TB standards.