Grant: Project Grant

The number of new tuberculosis (TB) cases among Canadian Inuit is 400 times that of Canadian-born non-Indigenous people. The federal government and Inuit Tapiriit Kanatami set a goal of eliminating TB across the Inuit homeland by 2030. Historically, community-wide TB screening has significantly reduced TB incidence among Canadian Inuit; however, it is labour-intensive and could take decades to complete. Better tools are needed to improve our ability to screen for TB in remote regions. Wastewater testing for COVID-19 has been used worldwide during the pandemic to screen populations in real-time. As a result, mycobacterium tuberculosis (Mtb), the bacteria that causes TB, has been identified in wastewater. The proposed study aims to follow TB trends in wastewater in Iqaluit, Nunavut, to see if this information can allow Inuit and their health providers to apply public health interventions to treat and stop TB transmission in their communities more effectively. The study will develop a sample logistical pathway for different established molecular tests and determine the significance of Mtb levels in wastewater. The study aims to use this tool to detect TB in buildings housing people at high risk for developing TB and to link this information to public health interventions. Lastly, the study will evaluate the feasibility of a community-wide TB wastewater screen. This study brings together four key disciplines: Nunavut TB clinical epidemiology (Alvarez), wastewater surveillance (Delatolla), TB-specific microbiology (Sun), and Inuit-specific research (Allen). We expect the outcome of this research will provide Inuit and their healthcare providers with a new tool that will assist in identifying and prioritizing those most at risk for TB, avoiding mass clinical testing of all individuals. This way, the public health teams can provide focused, efficient, and rapid clinical care to prevent the spread of this disease as we work toward TB elimination.