Abstract
Although Canada has one of the lowest tuberculosis incidence rates in the world, certain groups are disproportionately affected, including foreign born people from high incidence countries. The Winnipeg Regional Health Authority has initiated a process to decentralize latent tuberculosis infection (LTBI) management at primary care clinics in Winnipeg. One of these clinics is BridgeCare Clinic which provides services to government-assisted refugees. The present study describes the BridgeCare Clinic LTBI program and reviews program outcomes from January 2015 to October 2016. Refugees at BridgeCare Clinic receive comprehensive care, including LTBI screening and treatment. The LTBI program is managed by physicians, nurse practitioners, and primary care nurses under a patient-centered model of care. An accessible interpretation service, education to clients, and laboratory sampling at the clinic with free IGRA testing are important components of the program. Anonymized data on client outcomes were statistically analyzed and qualitative interviews were conducted with senior staff. During the study period, 274 IGRA tests were ordered with 158 negative results (57.7%) and 101 positive results (36.9%). Of 45 clients eligible (from January to December 2015) for LTBI treatment, 11 (24.4%) declined to receive treatment and 34 (75.6%) started treatment. Twenty-seven (79.4%) clients completed treatment, 3 (8.8%) clients moved out of province, and 4 (11.8%) did not complete treatment. The most recent World Health Organization strategy for tuberculosis control calls for integrated, patient-centered care and prevention. Aligned with these WHO recommendations, our experience suggests that LTBI care and treatment can be delivered effectively in a primary care setting using an integrated patient-centered approach.
Highlights
Canada has one of the lowest tuberculosis (TB) incidence rates in the world, certain groups are disproportionately affected, including foreign born people from high TB incidence countries [1]
Women and men between 18 and 49 years of age from a TB endemic country, defined as a country experiencing more than 30 cases of TB per 100,000 people every year [2], are eligible for latent tuberculosis infection (LTBI) screening with Interferon Gamma Release Assay (IGRA) as part of their intake
Our evaluation found a treatment acceptance rate of ∼ 76% and completion rate between 79 and 88%. These estimates compare favorably to those found by Manitoba Health, Seniors, and Active Living, indicating promising treatment completion outcomes at primary care sites for non-complex LTBI care [7]
Summary
Canada has one of the lowest tuberculosis (TB) incidence rates in the world, certain groups are disproportionately affected, including foreign born people from high TB incidence countries [1]. In 2016, TB among the foreign-born population accounted for 70% of reported cases (incidence rate of 15.2 per 100,000 population) in Canada, despite foreign-born residents representing only 22% of the total population [1]. Persons from high prevalence regions of Africa and South East Asia had the highest rates, 45.1 and 34.9 per 100,000 population, respectively. The two countries of origin that accounted for the most cases were India (n = 257, 21.2% of all foreign-born cases), and the Philippines (n = 252, 20.8% of all foreign-born cases) [1]. The foreign-born population accounted for only 33.8% of cases in the province of Manitoba, as Indigenous persons accounted for 61.7% of the cases (incidence rates were 30.8 and 53.9 per 100,000 population, respectively). Among foreign-born cases, the most frequent place of origin was the Western Pacific Region, with 38 of 68 cases (55.9%) [1]
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