Evaluation of TB elimination strategies in Canadian Inuit populations:Nunavut as a case study  

作　　者：Elaheh Abdollahi Yoav Keynan Patrick Foucault Jason Brophy Holden Sheffield Seyed MMoghadas 

机构地区：[1]Agent-Based Modelling Laboratory,York University,M3J 1P3,Toronto,Ontario,Canada [2]Department of Medical Microbiology,Max Rady College of Medicine,University of Manitoba,Winnipeg,R3E 0T5,Manitoba,Canada [3]National Collaborating Centre for Infectious Diseases,University of Manitoba,Winnipeg,R3E 0T5,Manitoba,Canada [4]Department of Family Medicine,Qikiqtani General Hospital,Iqaluit,X0A 0H0,Nunavut,Canada [5]Department of Pediatrics,University of Ottawa,Ottawa,K1N 6N5,Ontario,Canada [6]Department of Paediatrics,Qikiqtani General Hospital,Iqaluit,X0A 0H0,Nunavut,Canada

出　　处：《Infectious Disease Modelling》2022年第4期698-708,共11页传染病建模（英文）

基　　金：support from Natural Sciences and Engineering Research Council of Canada through Individual Discovery Grant.

摘　　要：Tuberculosis(TB)continues to disproportionately affect Inuit populations in Canada with some communities having over 300 times higher rate of active TB than Canadian-born,non-Indigenous people.Inuit Tuberculosis Elimination Framework has set the goal of reducing active TB incidence by at least 50%by 2025,aiming to eliminate it by 2030.Whether these goals are achievable with available resources and treatment regimens currently in practice has not been evaluated.We developed an agent-based model of TB transmission to evaluate timelines and milestones attainable in Nunavut,Canada by including case findings,contact-tracing and testing,treatment of latent TB infection(LTBI),and the government investment on housing infrastructure to reduce the average house-hold size.The model was calibrated to ten years of TB incidence data,and simulated for 20 years to project program outcomes.We found that,under a range of plausible scenarios with tracing and testing of 25%e100%of frequent contacts of detected active cases,the goal of 50%reduction in annual incidence by 2025 is not achievable.If active TB cases are identified rapidly within one week of becoming symptomatic,then the annual incidence would reduce below 100 per 100,000 population,with 50%reduction being met between 2025 and 2030.Eliminating TB from Inuit populations would require high rates of contacttracing and would extend beyond 2030.The findings indicate that time-to-identification of active TB is a critical factor determining program effectiveness,suggesting that investment in resources for rapid case detection is fundamental to controlling TB.

关 键 词：TUBERCULOSIS Inuit populations Treatment Agent-based simulation 2000 MSC 92B05 

分 类 号：R52[医药卫生—内科学]