Presentation on theme: "Community-Driven Tuberculosis Interventions for Aboriginal Communities"— Presentation transcript:
1 Community-Driven Tuberculosis Interventions for Aboriginal Communities The TBSAC Program is funded and delivered in partnership with the FNHAJessica Harper & Nash DhallaFebruary 19, 2015Hyatt Regency Vancouver
2 Conflict of Interest:Neither presenter (Nash Dhalla, RN, BScN or Jessica Harper, RN, BScN) have any affiliation financial or otherwise, with a commercial or other industry interest that may bias our presentation.
3 Outline TBSAC: Who we are What is TB? TST vs IGRA Feasibility of Portable Incubator in LTBI testingChallengesNext Steps
4 TB Services in BCCentralized: pharmacy, labs, database, physician consultant, and nurse consultant services provided by TB Services, BC Centre for Disease ControlTB Services for Aboriginal Communities (TBSAC): provides TB services to Health Centers located on-reserve, funded and delivered in partnership with First Nations Health Authority (FNHA).4
5 TB Services First Nations Communities TB Services for Aboriginal CommunitiesFirst Nations Health AuthorityCommunity Health NurseCommunity Health WorkerDOT WorkersHealth DirectorsCommunity MembersCDC Coordinator-TB, Funding, Education, ResourcesPhysician ConsultationNurse ConsultationCase ManagementPharmacy, Lab, Diagnostics, X-Ray, Surveillance, Training and Education
6 TB Team BCCDC (TBSAC) FNHA, Health Protection Dr. Victoria Cook, TBSAC PhysicianShawna Buchholz, Clinical Nurse EducatorNash Dhalla, Nurse ConsultantKaren Beinhaker, Nurse ConsultantFNHA, Health ProtectionJessica Harper, CDC Coordinator, TBTEAM AWESOME:
7 Background: What is TB? Curable and Preventable! Mycobacterium tuberculosisAirborne diseaseGenerally infects the lungsIn BC: incidence rate of ~7 perSymptoms: coughing, fever, weight loss, night sweatsCurable and Preventable!BC: Foreign Born – rate is 18.9 per , Aboriginal on-reserve and on –reserve is 40.3
8 Background: What is LTBI? “Sleeping” Latent TB infection (LTBI):Infected with bacteria? YESSymptoms present? NOInfectious? NOA healthy individual infected with LTBI has a 5-10% risk of developing active TB over their lifetime(BCCDC TB Control Manual, 2012)
9 Background: Diagnosing & Treating LTBI Tuberculin Skin Test (TST) is an intradermal injection of 0.1ml of purified protein derived from M.Tuberculosis bacteriaFollow up Chest X-ray to check for active TB
10 Background: Diagnosing & Treating LTBI Recommended for preventative therapy:Isoniazid for 9 months –270 dosesORRifampin for 4 months –120 dosesDecision to start treatment is based on:Context of TST – likelihood of false positiveReason client was being testedRisk of progression to active diseaseAbility to adhere to medicationPossible intolerance to medicationAlcohol use, desire for pregnancy, etc.(BCCDC TB Control Manual, 2012)
11 The IGRA Test Interferon Gamma Release Assay (IGRA) Detects interferon gamma released from WBCTwo tests: Quantiferon Gold and T-SpotBC: offered in Vancouver, New Westminster, Victoria, Prince George and Kelowna
12 IGRA vs. TST(TB Manual: Interferon Gamma Release Assay Testing Guideline for Diagnosis of Latent Tuberculosis Infection by Physicians, 2013, pg. 2)
13 TST vs. IGRA TST IGRA Good for serial testing Not as good for serial testingInexpensiveMore expensiveUniversally accessibleSkill, equipment and timeframe needed limit accessibilityLow specificity in certain populations (BCG-60%)High specificity in all populationsTwo visitsOne visitVariability in test interpretation by reader *****Low variability in test interpretation by reader
14 WHY IGRA?To identify the proportion of patients in whom treatment for LTBI could be avoided because an IGRA test was negative yet a TST test was positive.To determine if there is a statistically significant difference in treatment adherence between BC residents who have had LTBI confirmed with an IGRA test and those whose diagnoses was made using a TST only.
15 IGRA Feasibility In First Nations Communities Currently IGRA is offered at the BCCDC, in New Westminster, Victoria, Kelowna and Prince GeorgeIncrease access to testing for patients who are less likely/able to travel for testing:Remote communitiesOutbreak investigationEnhanced communitiesIdentify and treat true LTBIAre communities interested in the IGRA test?
16 IGRA testing: Feasibility TBSAC Team & Community Leaders discussed IGRABased on enhanced community surveyStrong links with HCPGeographic locationIGRA available in Canada 2007 with strong evidence baseBCG FactorCommunity engagement
17 Results: Feasibility Test Community approvalMeet with BCCDC lab to agree on expectations of how samples are deliveredDevelop detailed protocol on sample collection, processing and transportation to labConfirm site visit date(s)Conduct site visit & feasibility testDetermine resultsSummarizing resultsLessons learned
18 Vision of the FNHAIn partnership with BC First Nations Communities the FNHA TBSAC program is working towards the Vision of: “Healthy, Self-determining and Vibrant BC First Nations Children, Families and Communities.”Directives:1-Community Driven, Nation Based2 increase FN Decision making and control3Improve services4Foster meaningful collaboration and partnership
19 Thank You! Acknowledgements First Nations Communities BCCDC- Zoonotic LabYvonne SimpsonMuhammad MorshedQuantine WongFNHA and TBSAC teamApril MacNaugtonDr. Isaac SobolDr. Victoria CookJane LopezMaggie WongShawna BuchholzKaren BeinhakerFirst Nations CommunitiesHealthcare ProfessionalsCommunity membersCommunity leadersThank You!