Screening for latent tuberculosis infection by an Aboriginal Community Controlled Health Service, New South Wales, Australia, 2015
DOI:
https://doi.org/10.5365/wpsar.2018.9.2.010Abstract
Objective: Ongoing transmission of tuberculosis (TB) continues in Indigenous communities in New South Wales (NSW), Australia. In a pilot project, a Public Health Unit TB team partnered with an Aboriginal Community Controlled Health Service (ACCHS) in a community with a cluster of TB to augment screening for latent TB infection (LTBI) using interferon-gamma release assay (IGRA). This study examined screening data and programme outcomes at 12 months post hoc to advise practice and policy formulation.
Methods: We conducted a retrospective, cross-sectional analysis of demographic and clinical data of ACCHS patients, stratified by IGRA testing status. Differences in sex and age distribution between the groups and cases of a genetically and epidemiologically linked TB cluster in Aboriginal people in NSW were assessed using non-parametric tests.
Results: Of 2019 Aboriginal and Torres Strait Islander people seen by general practitioners during the study period, 135 (6.7%) participated in the screening. Twenty-four (17.8%) participants were IGRA positive. One person was diagnosed with active TB. Twelve participants received a chest X-ray at the time of the positive test, and six participants had an additional chest X-ray within 12 months. None commenced preventive treatment for LTBI.
Discussion: ACCHS screening for LTBI reached individuals in the age group most commonly affected by TB in these Aboriginal communities. No conclusions can be made regarding the population prevalence due to the low screening rate. Further strategies need to be developed to increase appropriate follow-up and preventive treatment.
References
World Health Organization. (2017). Global tuberculosis report 2017. Retrieved from http://www.who.int/tb/publications/global_report/en/
Toms, C., Stapledon, R., Waring, J., Douglas, P. et al (2015). Tuberculosis notifications in Australia, 2012 and 2013 Comm Dis Intell. 39(2): E217-35
Robertus, L. M., Konstantinos, A., Hayman, N. E. and Paterson, D. L. (2011), Tuberculosis in the Australian Indigenous population: history, current situation and future challenges. Australian and New Zealand Journal of Public Health, 35: 6–9. doi:10.1111/j.1753-6405.2010.00663.x
World Health Organization. (2014). The End TB Strategy. Retrieved from http://www.who.int/tb/strategy/end-tb/en/
National Tuberculosis Advisory Committee (NTAC). (2012). The Strategic Plan for Control of Tuberculosis in Australia: 2011–2015. Communicable Diseases Intellegence, 36(3), E286-E293.
Mack, U., Migliori, G. B., Sester, M., Rieder, H. L., Ehlers, S., Goletti, D., et al and TBNET. LTBI: latent tuberculosis infection or lasting immune responses to M. tuberculosis? A TBNET consensus statement. Eur Respir J 2009; 33:956–73.
Comstock, G. W., Livesay, V.T., Woolpert, S.F. (1974). The prognosis of a positive tuberculin reaction in childhood and adolescence. Am J Epidemiol 1974; 99:131–8.
Menzies, D., Jahaldi, H., Otiaibi, B. (2011). Recent developments in latent tuberculosis treatment. IJMR, 2011. 133 (3)
Centers for Disease Control and Prevention. (2013). Latent TB Infection/ Treatment- A Guide for Primary Health Care Providers. Retrieved from http://www.cdc.gov/tb/publications/ltbi/pdf/TargetedLTBI.pdf
World Health Organization. (2015) Guidelines on the management of latent tuberculosis infection WHO 2015. Retrieved from http://www.who.int/tb/publications/ltbi_document_page/en/
National Tuberculosis Advisory Committee. (2012). Position statement on interferon-γ release assays in the detection of latent tuberculosis infection. Comm Dis Intell. 36(1): 125-131
Devlin, S., Passmore, E. (2013). Ongoing transmission of tuberculosis in Aboriginal communities in NSW. N S W Public Health Bull. 2013 Jul;24(1):38-42. doi: 10.1071/NB12113.
Rudge, S., Massey, P. D. (2010). Responding to pandemic (H1N1) 2009 influenza in Aboriginal communities in NSW through collaboration between NSW Health and the Aboriginal community-controlled health sector. New South Wales Public Health Bulletin 2010; 21: 26–29.
World Health Organization. (2014). Framework towards TB elimination in low- incidence countries. Retrieved from http://www.who.int/tb/publications/elimination_framework/en/
Dehghani, K., Lan, A., Li, P., Wilk Michelsen, S., Waites, S., Benedetti, A., Lejeune, P., Torrie, J., Robinson, E., Vejoda, B., Mullah, M., Redwood, D., Cooper, M., Fanning, A., Yacoub, W., Alvarez, G. G., Søborg,, B., Long, R., Menzies, D. (2018). Determinants of tuberculosis trends in six Indigenous
populations of the USA, Canada, and Greenland from 1960
to 2014: a population-based study. Lancet Public Health 2018;
: e133–42. Published Online February 6, 2018 http://dx.doi.org/10.1016/
S2468-2667(18)30002-1
Centers for Disease Control and Prevention. (2015). Tuberculosis (TB), Latent tuberculosis infection-A guide for Primary Health Care Providers. Retrieved from https://www.cdc.gov/tb/publications/ltbi/treatment.htm
