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The Conversation: Fighting tuberculosis: Databases are new and powerful weapons

January 30, 2019 — 



The Conversation


The following story was published on The Conversation from Lisa Lix, Chair in Methods for Electronic Health Data Quality, professor of community health sciences and senior researcher with the Manitoba Centre for Health Policy at the U of M: 

Tuberculosis (TB) is one of the top 10 global causes of death. It is caused by bacteria that first settle in the lungs and spread through the air and is passed on when a person with an active infection coughs or sneezes. People can also pass on TB when they are not themselves sick, if they have a “sleeping” or “latent” infection.

Treatments have been available since the 1940s and TB can be treated before an infected person feels symptoms. However, TB continues to spread in Canada and globally.

It is extremely important that people with active and latent TB infections receive treatment to eliminate the bacteria. The World Health Organization’s End TB Strategy aims to drastically reduce TB deaths and new cases by the year 2035. It identifies local databases as essential for meeting this goal.

I recently completed a study with First Nations representatives, research experts, and Dr. Pierre Plourde, medical health officer and medical director of integrated tuberculosis services at Winnipeg Regional Health Authority, to investigate TB in Manitoba.

We found that although treatment of latent TB infections is on the rise, there is still a lot of work ahead. Rates have yet to reach the recommended 80 per cent completion target.

People with active TB have more emergency room, hospital and family physician visits before receiving a diagnosis. Each visit is an opportunity for diagnosis and monitoring the progression of treatment.

Health databases are vital

We used Manitoba’s administrative health databases to investigate use of the health system by people with active and latent TB. We looked at the characteristics of people who have come in contact with TB. And we examined the health outcomes of people with active and latent TB infections.

Manitoba’s TB Registry database takes account of all individuals who have been diagnosed with an active TB infection and those who have received treatment for latent TB infection.

Linking the TB Registry to other health and social databases tells us a lot about who in Manitoba has TB and what health services these people receive. Active TB disproportionately affects Indigenous people, and populations born outside of Canada.

Indigenous people make up only four per cent of the Canadian population. However, surveillance data provided by the Public Health Agency of Canada indicates that more than a fifth of reported cases of active TB affect Indigenous persons.

These databases are essential for surveillance, research and program evaluation that can inform local strategies to end TB.

Patients must complete treatments

Treating people with latent TB is important for preventing new TB cases, but this is easier said than done. Those with latent TB need to be on medication for several months to completely get rid of their infection, even while they don’t feel sick.

It can be difficult to stick with the treatment for that long, especially when the side effects may cause the person to feel unwell.

The World Health Organization recommends that more than 80 per cent of patients treated for latent TB infection need to complete their treatments to prevent the spread of the disease.

Rates are increasing but there is still a ways to go to meet the recommendations.

Read more: More than one in 100 Nunavut infants have TB

TB registries and other databases can help. But there is still more work to be done to ensure all populations are captured in the data for early detection of TB.

Early identification is key

Steps can be taken for better use of the data available — to set up programs to identify people who have a latent TB infection across Manitoba as early as possible.

Partnerships with communities most impacted by TB are essential to ending TB through earlier diagnosis and improved delivery of known effective treatments.

Data can help us to learn more about the impacts of TB in the community. Building partnerships with members of the community to interpret data and have input about the data collected helps everyone to work together to end TB. This will reduce missed or delayed diagnoses and enable faster delivery of care.

Strong partnerships with First Nations leaders, governments and researchers, along with quality health data, are key to preventing, treating and ultimately putting an end to tuberculosis in Canada.

With the support of partners we can make better use of the data we have to identify active and latent TB infections and to improve how people with infections use the health-care system. Together we can end tuberculosis in Canada.

Research at the University of Manitoba is partially supported by funding from the Government of Canada Research Support Fund.

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