Taima (stop) TB: the impact of a multifaceted TB awareness and door-to-door campaign in residential areas of high risk for TB in Iqaluit, Nunavut.

Gonzalo G Alvarez,Shawn D Aaron,Natasha Stephen,Natan Obed,Katherine Moreau,D William Cameron,Maureen Baikie,Geraldine Osborne,Deborah D Vandyk,Ranjeeta Mallick,Franco Momoli,Naomi Davies,Jianming Tang

doi:10.1371/journal.pone.0100975

Abstract

BackgroundThe incidence rate of active tuberculosis (TB) disease in the Canadian Territory of Nunavut has shown a rising trend over the past 10 years. In 2010 it was 60 times greater than the national incidence rate. The objective of the Taima (translates to “stop” in Inuktitut) TB study was to implement and evaluate a public health campaign to enhance existing TB prevention efforts in Nunavut.MethodsA TB awareness campaign followed by a door-to-door screening campaign was carried out in Iqaluit, Nunavut. The aim of the campaign was to raise awareness about TB, and to provide in-home screening and treatment for people living in residential areas at high risk for TB. Screening was based on geographic location rather than on individual risk factors.ResultsDuring the general awareness campaign an increase in the number of people who requested TB testing at the local public health clinic was observed. However, this increase was not sustained following cessation of the awareness campaign. Targeted TB screening in high risk residential areas in Iqaluit resulted in 224 individuals having TSTs read, and detection of 42 previously unidentified cases of latent TB, (overall yield of 18.8% or number needed to screen = 5.3). These cases of latent TB infection (LTBI) were extra cases that had not been picked up by traditional screening practices (34% relative increase within the community). This resulted in a 33% relative increase in the completion of LTBI treatment within the community. The program directly and indirectly identified 5/17 new cases of active TB disease in Iqaluit during the study period (29.5% of all incident cases).ConclusionsWhile contact tracing investigations remain a cornerstone of TB prevention, additional awareness, screening, and treatment programs like Taima TB may contribute to the successful control of TB in Aboriginal communities.

Highlights

The incidence rate of active tuberculosis (TB) disease in the Canadian Territory of Nunavut has shown a rising trend over the past 10 years
An increase in passive latent TB infection (LTBI) screening at the local Iqaluit public health clinic was observed during the Taima TB media engagement and general awareness campaign
The number of people who came to the clinic (‘‘walk-ins’’) increased from an average of 26 per month over the previous four years to an average of 50 people per month during the four months of Taima TB’s general awareness campaign (p,0?0002)

Summary

Introduction

The incidence rate of active tuberculosis (TB) disease in the Canadian Territory of Nunavut has shown a rising trend over the past 10 years. In the early 1960s the incidence rate (per 100,000) of active tuberculosis (TB) disease in the Canadian territory of Nunavut (previously part of the Northwest Territories) was over 1000 [1]. In the 1960s, public health teams treated entire northern communities with preventive treatment [1,2], and cases with active TB disease were sent to sanatoriums in the south of Canada in order to prevent further transmission [3,4]. The incidence rate of active TB disease in Nunavut has shown a rising trend over the past ten years and reached 304 in 2010 (representing 101 active cases) compared to the Canadian rate of 4?6 during the same year [3,4]. The incidence rate among First Nations is 22?2/100,000, Metis is 7?5/100,000 versus 198?6/100,000 among Inuit [7]

Objectives

Methods

Results

Discussion

Conclusion