Guidance for Tuberculosis Prevention and Control Programs in Canada

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Guidance for Tuberculosis Prevention and Control Programs in Canada
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Preface

Drawing extensively from the work of tuberculosis (TB) experts across the country, Guidance for Tuberculosis Prevention and Control Programs in Canada represents an important step forward in our efforts to reduce the burden of TB in Canada. It offers stakeholders a modern, evidence-based approach to TB prevention and control that respects and responds to jurisdictional roles and responsibilities. As a compendium of best practices, it also serves as an important resource for frontline public health practitioners working to decrease the incidence and prevalence of TB within populations most at risk.

The major intent of this guidance document is to inform ongoing program delivery and development by providing decision-makers, health care providers and program planners with information on all aspects of TB prevention and control. It complements and aligns with the Canadian Tuberculosis Standards and Health Canada’s Strategy Against Tuberculosis for First Nations On-Reserve and, as such, will figure as a key component in a future Canadian framework for action on TB.

The best practices articulated in Guidance for Tuberculosis Prevention and Control Programs in Canada reflect the knowledge and expertise Canada has acquired over decades of involvement in the fight against TB. It is our hope that all stakeholders – whether service providers, policy makers or laboratory scientists – can apply the se best practices to their work on behalf of all Canadians.

Dr. David Butler-Jones,
Chief Public Health Officer of Canada
Federal Co-Chair, Public Health Network Council

Dr. André Corriveau,
Chief Medical Health Officer, Northwest Territories
Provincial/Territorial Co-Chair, Public Health Network Council

Acknowledgements

We would like to acknowledge the contributions of the following groups and individuals:

  • Members of the former Canadian Tuberculosis Committee members, including Ruth Anne Appl, Cheryl Case, Alexander Doroshenko, Edward Ellis, Kevin Elwood, Danielle Grondin, Elaine Holmes, Frances Jamieson, Klaus Jochem, (ex-officio), Joel Kettner, Richard Long, Sylvie Martin (ex-of ficio), Dick Menzies, Heather Morrison, Pamela Orr, Linda Panaro, Linda Poffenroth, Elaine Randell, Elizabeth Rea, Paul Rivest, Beth Roberts, George Samuel, Derek Scholten (ex-officio), Debbie Smith, Geetika Verma, Wendy Wobeser, Joyce Wolfe and Marion Yetman.
  • The Communicable and Infectious Disease Steering Committee, co-chaired by Horacio Arruda and Rainer Engelhardt.
  • The many individuals with the Public Health Agency of Canada and Health Canada who collaborated with us on this publication. Special thanks to Chris Archibald, Jocelyne Courtemanche, Howard Njoo, Carolyn Pim and Tom Wong.

Table of Contents

Executive Summary

Part I - Background

  • The global context of TB
  • TB in Canada
  • Overall goals for Canada

Part II - Optimizing Current Tuberculosis Prevention and Control Efforts

  1. The TB program
  2. Management of active TB disease
  3. Contact tracing and outbreak investigation
  4. Screening
  5. Surveillance and data management
  6. TB laboratory services
  7. Education and professional practice
    1. Health care provider education
    2. Professional practice
  8. Community-based awareness
  9. Monitoring and evaluation
  10. High-risk populations and settings
    1. First Nations, Inuit and Métis
    2. Migrants from countries with high TB incidence
    3. The homeless and underhoused
    4. Institutional settings
  11. Strategies to address emerging issues
    1. TB and HIV co-infection
    2. Drug-resistant TB
  12. Social and other determinants of health related to TB
  13. Research

Part III - Responsibilities, Partnerships and Linkages

  • Federal
  • Provincial/territorial/municipal
  • Academic and health sectors
  • Partnerships and linkages

Part IV - International Collaboration

Conclusion

Appendices

  • Appendix I – Definition of terms and abbreviations
  • Appendix II – Epidemiology of TB in Canada
  • Appendix III – Legislation with application to TB prevention and control
  • Appendix IV – Potential TB program objectives and performance targets
  • Appendix V – Related documents and resources

References

Executive Summary

Tuberculosis (TB) remains an important and serious global public health challenge that requires coordinated international and national prevention and control efforts. Although the incidence of TB in Canada is low and the disease is no longer common in the general population, TB remains a serious problem in certain sub-populations, such as First Nations and Inuit, persons living in Canada who have arrived from regions of the world with a high incidence of TB and those with other health problems like HIV/AIDS. The many and varied conditions in which Canadians live mean that the risks and impacts of TB are not uniformly distributed within our boundaries. There is a pressing need to better understand and target groups at increased risk, and tailor prevention and control efforts to meet their specific needs. In addition, resistance to some of the drugs used to treat TB is a growing problem in some countries. In a globalized, interconnected world the implications of drug-resistant strains are a concern for all nations.

Dealing with these issues in the Canadian context requires a modern, evidence-based approach that recognizes and mitigates both global and domestic influences. TB control is a shared responsibility among individuals, communities, governments and civil society. In response to the continuing presence of TB in Canada and the ongoing challenges in its prevention and control, the current document provides a framework and guidance for optimal TB control, through the adoption of best practices aimed at reducing the disease nationally and internationally.

The expectation is that a pan-Canadian approach to TB prevention and control will result in more highly coordinated, multisectoral action in addressing TB, while at the same time recognizing provincial and territorial responsibilities for the delivery of health services.

The existence of comprehensive Canadian objectives supports federal, provincial/territorial and local prevention and control efforts. The objectives, approaches and best practices outlined in this guidance document are consistent with internationally agreed upon targets and program components.

With an overarching goal of reducing the national incidence rate of reported TB in Canada to 3.6 per 100,000 or less by 2015, the principal activities are:

  • Timely diagnosis and treatment of active cases, with special attention paid to HIV co-infection and drug-resistant cases
  • Contact tracing and management of those found to have active TB disease or latent TB infection (LTBI)
  • Screening and treatment of LTBI in high-risk populations
  • Primary prevention aimed at stopping the cycle of transmission, in part through effective partnerships and interventions to address the social and other determinants of health

These activities must be supported by appropriate legislation and policy; strong laboratory services; public health surveillance; monitoring and evaluation; TB-related research; and adequately trained health professionals.

Many of the best practices described in this document are already in place in most provinces and territories. However, other best practices are not universally implemented; consequently, there remains a need to stimulate action towards improvements in TB-related services. For effective TB prevention and control, evidence points to the fact that all key components should be coordinated through an organized TB program.