Mobile Latent Tuberculosis Infection Testing for Aboriginal Communities

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In Canada, Aboriginals are more likely to have Latent Tuberculosis than Canadian-born non-Aboriginals because of their social determinants of health as well as historical and physical conditions. And, as is the case in most rural communities, accessing primary care services is a challenge and significant barrier to care.

Interferon-Gamma Release Assays (IGRA) are a new advancement that use blood tests to diagnose Latent Tuberculosis Infections (LTBI) up to 35% more accurately than traditional skin tests. But, due to processing time sensitivities, the need for specialized training and the sophisticated equipment required for the tests, IGRAs are currently only available in BC in one of the five urban sites.

Tuberculosis Services for Aboriginal Communities is a collaborative program delivered by the BC Centre for Disease Control and the First Nations Health Authority that decided to bring IGRAs to Aboriginal communities. By using portable incubators in the field the program is able to remove access barriers to care, create opportunities for more accurate as well as earlier preventative and curative interventions, and discuss issues of fear and stigma related to Tuberculosis.

The testing’s primary objective is to identify individuals who are at increased risk for developing active Tuberculosis and therefore would benefit from treating LTBI. It also reduces the high rate of false positives generated by skin tests and their subsequent economic (e.g. cost of medications, follow up medical appointments) and psychosocial (e.g. medication side effects, stigmatization) costs. More accurate test results also prevent patients who do not have LTBI from being prescribed unnecessary toxic medications that may predispose them to severe side effects and cause liver function damage.

The program started by working with First Nations communities’ elders, members and band staff to review and develop a community questionnaire. Team members then attended health fairs in two communities and directly asked members and band staff the questionnaire’s questions in order to assess individual interest in IGRA testing.

Working with the BC Public Health Microbiology and Reference Laboratory, the program next developed guidelines to support IGRA testing in First Nations communities:

• Two program nurses visit First Nations communities to facilitate testing and provide education on preventative therapy and its personal and social benefits. This culturally-safe model creates opportunities to acknowledge and discuss issues of historical fear and stigma related to Tuberculosis care in BC, leading to enhanced uptake of treatment for preventative therapy.
• Blood samples are taken and maintained in a portable incubator and centrifuged, and then delivered to BC Public Health Microbiology and Reference Laboratory for processing.
• Lab reports are sent to community health nurses and responsible physicians. The program’s nurses provide consultation services.

To date, the program has visited eight First Nations communities and completed 73 IGRA tests on members with had previous positive Tuberculosis skin tests. 55 of the 73 IGRA tests (75%) showed that positive TB skins tests were actually false positives. These members would have been offered unnecessary preventative treatment for LTBI.

This testing model has been shared and is currently being implemented in Correctional Services Canada. It is also being submitted as a leading practice to Accreditation Canada and received an Award of Merit in the 2014 HEABC Excellence in Health Care Awards. The program may use its $2,500 sponsorship for school screenings, co-sponsoring community events and purchasing testing equipment.