In the Canadian province of Nunavut, geographic remoteness, harsh climate and historic disadvantages have exacerbated public health inequities for its predominantly Inuit population.
Perhaps the most illustrative indicator of these disparities is the region’s decades-long struggle with tuberculosis (TB) infections, which have an incidence rate 450 times higher than the Canadian national average. A series of unsuccessful TB elimination efforts have fostered consternation among Nunavut residents and Canadian public health authorities alike. An exception to this fraught record was explored by Zwerling and colleagues in the October 2024 edition of The Lancet Regional Health – Americas, in which the authors focused on the epidemiological success and cost-effectiveness of a community-wide screening initiative in a small Nunavut town.
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The authors provided a framework and protocol for community-wide screening that merits further exploration for its application in other communities across the province. GlobalData epidemiologists forecast that the diagnosed incident cases of TB infection in Canada will grow from almost 2,000 cases in 2024 to more than 2,100 cases in 2033. If efforts such as those presented by Zwerling and colleagues are successfully replicated in other communities, the number of infections may fall short of this projection due to enhanced intervention in the country’s most afflicted region.
A potentially valuable tool for curbing infections
Zwerling and colleagues analysed the results of a community-wide screening programme implemented during 2018 in Qikiqtarauq, Nunavut. In this community of 625 predominantly Inuit residents, provincial health authorities aimed to detect and treat all cases of TB using a portable clinic, accompanied by campaigns encouraging community members to seek screening. The intervention successfully screened 514 members of the community, 11 of whom received a new tuberculosis diagnosis in addition to 157 previously diagnosed. Among those who tested positive, all active TB patients were promptly treated and 78 of 105 patients with latent infection received a full course of treatment.
Follow-up monitoring and a cost-effectiveness analysis suggested that the community-wide screening initiative reduced the incidence of new infections and halted the progression of early-stage illness at a relatively low cost. These results bolster the case for community-wide, as opposed to targeted, screening and treatment programmes, as well as highly engaged awareness campaigns that reduce the stigma associated with seeking care.
The intervention evaluated by Zwerling and colleagues charts an effective, affordable framework for TB control in Nunavut. These initial results necessitate further exploration to determine if community-wide screening yields similar results in other Nunavut communities before being formalised into a wider public policy. Furthermore, it raises the possibility for application to other locales and historically disadvantaged populations — a prospect that also deserves further scholarly exploration. If further inquiry validates the efficacy of the community-wide screening approach, its widespread utilisation could be a valuable tool in Canada’s historically fraught attempts at curbing infections among one of its most vulnerable populations.
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