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Addressing tuberculosis among Inuit in Canada.

M Patterson1, S Flinn1, K Barker1

  • 1Ministry of Health, Government of Nunavut, Iqaluit, NU.

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|April 23, 2019
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Summary
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Tuberculosis (TB) rates are over 290 times higher in Canada's Inuit population due to social determinants and healthcare access issues. Despite challenges, advancements in diagnostics, treatment protocols, and a dedicated task force offer hope for TB elimination.

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Area of Science:

  • Public Health
  • Epidemiology
  • Indigenous Health

Background:

  • Tuberculosis (TB) rates among Inuit in Canada are exceptionally high, exceeding those of non-Indigenous Canadians by over 290 times.
  • Social determinants of health, including overcrowded housing, food insecurity, and high smoking rates, significantly contribute to the TB burden in Nunavut.
  • Healthcare access in Nunavut is hampered by geographical isolation, harsh weather, limited resources, staff shortages, and a lack of cultural knowledge.

Purpose of the Study:

  • To investigate the root causes of the disproportionately high tuberculosis rates among the Inuit population in Canada, using Nunavut as a case example.
  • To highlight the interplay between social determinants of health, healthcare access challenges, and the prevalence of TB in the region.
  • To document ongoing efforts and advancements in TB care and elimination strategies within Nunavut.

Main Methods:

  • Analysis of social determinants of health impacting TB rates in Nunavut, including housing, food security, and smoking prevalence.
  • Examination of challenges in healthcare delivery within isolated communities, such as logistical difficulties and staffing issues.
  • Review of current TB control measures, including active case finding, contact tracing, rapid diagnostics (GeneXpert), digital radiography, and updated treatment protocols (e.g., 3HP therapy).

Main Results:

  • Significant disparities in TB rates are linked to socioeconomic factors and systemic barriers to healthcare access in Nunavut.
  • Technological advancements like GeneXpert and digital X-rays have improved diagnostic speed and efficiency.
  • Revised treatment regimens, including 3HP therapy and directly observed treatment (DOT), enhance adherence and reduce resource needs.
  • A dedicated Inuit TB Elimination Action Framework Task Force has been established to drive long-term change.

Conclusions:

  • Addressing social determinants of health and improving healthcare access are critical for reducing TB rates among Inuit in Canada.
  • Current advancements in diagnostics and treatment offer promising avenues for TB control and eventual elimination.
  • Collaborative efforts, such as the Inuit TB Elimination Action Framework, are essential for achieving long-term success in TB elimination.