Tuberculosis among northern Manitoba First Nations, 2008-2012: program performance on- and off-reserve.

Area of Science:

• Public Health
• Epidemiology
• Indigenous Health

Background:

• Tuberculosis (TB) remains a significant public health concern, particularly among Indigenous populations.
• Effective TB program performance measurement is crucial for targeted interventions and resource allocation.
• Understanding disparities in TB care between on-reserve and off-reserve First Nations communities is essential for equitable health outcomes.

Purpose of the Study:

• To evaluate tuberculosis (TB) program performance among northern First Nations in Manitoba.
• To demonstrate methods for measuring TB program performance using routinely collected surveillance data.
• To stimulate dialogue on enhancing Canadian TB programs through performance measurement.

Main Methods:

• A retrospective cohort study analyzed data from the Manitoba TB Registry (2008-2010).
• Performance measures, adapted from US-CDC guidelines, were assessed for individuals diagnosed with TB and their contacts.
• Statistical comparisons between on-reserve and off-reserve First Nations were adjusted for age, sex, and treatment history.

Main Results:

• A cohort of 149 TB cases and 3560 contacts was identified.
• Lower rates of HIV testing and reporting (aPR=0.42) and contact assessment (aPR=0.69) were observed off-reserve.
• Higher pediatric TB incidence (37.1/100,000/year) was noted in northern Manitoba, with a trend towards increased retreatment for TB (aPR=0.93).

Conclusions:

• TB program performance shows variability based on First Nations' on-reserve or off-reserve status.
• Targeted interventions are required to improve contact investigation and HIV testing/reporting for off-reserve First Nations.
• Addressing high pediatric TB rates in northern Manitoba and fostering First Nations collaboration are vital for improving overall TB program performance.