Grant: Operating Grant - PA: First Nations, Inuit and Metis Health

Tuberculosis (TB) remains one of the most important global public health problems. In 2009, Aboriginal people had a TB incidence rate 6 times higher than the Canadian average, a pattern which dates back 120 years. In Nunavut in 2010, the TB rate was 350/100,000-70 times the Canadian average. In one Nunavik (Northern Quebec) community, an ongoing epidemic has seen nearly 10% of the population develop active TB disease over a one-year period. TB rates in such communities now exceed those in many developing countries. Smoking, heavy alcohol use and diabetes are all strong risk factors for developing TB, with the first two highly prevalent in the North. Importantly, there are several potential interventions to address these conditions. Current global TB control is based primarily on the World Health Organization's 25 year-old "Directly observed treatment, short-course" strategy. However, given the burden of TB attributable to smoking, alcohol use, diabetes, and overcrowded housing, the benefits of reducing their prevalence may include a substantial reduction in TB disease and mortality. We will use computer simulation (decision analysis) to predict benefits and cost effectiveness of two potential approaches to TB control in Aboriginal populations. The first focuses on i) smoking prevention/cessation; ii) reduction of heavy alcohol use; iii) diabetes prevention; and iv) improved housing, to prevent TB disease, and improve outcomes. The second, TB-specific approach involves i) enhanced diagnosis of latent TB; ii) active TB case finding and iii) a new, rapid diagnostic test for active TB. These allow preventive treatment and earlier diagnosis, potentially reducing mortality and transmission. We will compare predictions of active TB cases averted, deaths prevented and quality-adjusted life years gained, and costs, including those borne by patients and families. This research will help communities, health care providers and funders tackle complex TB epidemics.