Grant: Project Grant

Tuberculosis (TB) causes more deaths worldwide than any other infectious agent: 1.5 million deaths in 2018. The World Health Organization has set key targets for TB reduction and elimination. For countries like Canada, with higher income and lower TB incidence, the targets are to reduce incidence to 1 case per 100,000 population by 2035, and to 1 per million by 2050. However, Canadian TB rates have not changed for over a decade, and have reached a plateau just under 5 cases per 100,000. Over 70% of these cases occur in foreign-born persons. Progress toward elimination will not be possible without better approaches to prevention in this group. This proposal uses computer simulation of tuberculosis epidemiology and trends to examine the potential impact and cost of potential new approaches, over the period between 2020 and 2050. Specifically, we will: 1.Predict the long-term epidemiologic and economic impact of broadened pre- and post-migration screening for dormant TB infection among migrants to Canada. 2.Predict the impact of shorter, more effective, and safer treatment regimens for dormant TB infection, as well as the impact of new technologies, such as better tests for dormant infection, and a new TB vaccine, among migrants. 3.Consider the impact of investment in specific elements of TB prevention and care in high-incidence countries, with respect to their downstream implications for Canada and other countries which receive large numbers of migrants. 4. Consider the ethical implications of these new approaches, including potential stigmatization and treatment risks. This work will provide relevant information to decision makers, including public health and immigration medical authorities. It will also pave the way for better information sharing and input from affected communities. Findings will also be highly relevant to other low-incidence, higher-income, migrant receiving countries.