Tuberculosis Research - Ayel L. R. Batac

TUBERCULOSIS

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Tuberculosis (TB) remains a major public health concern in remote Arctic communities across Canada, where incidence rates are consistently the highest in the country. Despite long-standing efforts to control and eliminate the disease, TB continues to re-emerge in the form of outbreaks, particularly in geographically isolated settings where social and structural challenges persist.

In these contexts, barriers such as limited access to healthcare, overcrowded housing, and long-standing distrust in public health systems undermine prevention and control efforts. These challenges are often compounded by logistical obstacles—such as seasonal mobility, infrastructure limitations, and staff turnover—that constrain timely diagnosis and treatment.

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Community-Wide Screening as a Public Health Strategy

One of the most promising interventions to disrupt TB transmission in high-burden regions is community-wide screening. This approach involves proactively offering screening to all members of a community—regardless of symptoms—to detect both latent TB infection (LTBI) and active TB disease.

The benefits of community-wide screening include:

• Reducing time to diagnosis, thereby interrupting transmission chains
  
• Identifying latent infections before they progress to active disease
  
• Providing culturally adapted outreach and education to increase participation
  
• Strengthening community trust through local leadership and engagement

Previous implementations of community-wide screening in Nunavut, Canada, have demonstrated both effectiveness and cost-efficiency when adapted to local realities. When combined with targeted health promotion and community-driven planning, these initiatives support early detection, treatment uptake, and long-term disease control.

Ongoing Research

My current work focuses on the evaluation of a community-wide screening clinic conducted in response to a TB outbreak in Nunavut. This evaluation examines how the initiative:

• Detected and treated both active and latent TB cases
  
• Promoted awareness and reduced stigma through bilingual outreach
  
• Addressed barriers to participation and treatment completion
  
• Applied lessons from previous community-wide screening efforts to strengthen delivery

This research contributes to operational knowledge on how community-based strategies can strengthen TB prevention and control in remote, high-incidence regions.

Methodological Approach

This evaluation takes a quantitative, epidemiological approach to assess the outcomes of a community-wide screening initiative conducted in response to a tuberculosis outbreak in Nunavut. Program data were analysed to examine screening coverage, diagnostic outcomes, and treatment initiation for both active TB and LTBI.

The study also highlights the critical role of community engagement and local leadership in the success of the community-wide screening. The planning and implementation process incorporated culturally grounded strategies to promote trust, reduce stigma, and enhance participation. Clinic delivery was shaped by coordinated interagency efforts and informed by previous screening initiatives in the territory.

By combining epidemiological findings with high-level insights into operational planning and community engagement, this evaluation provides practical evidence to guide future TB control efforts in remote and high-incidence settings—while respecting the local context and the principles of cultural safety.

Contribution to Public Health

This research advances understanding of how community-wide screening can serve as an effective and context-sensitive strategy for TB control in remote Arctic communities. Key contributions include:

• Providing real-world evidence on the epidemiological impact of community-wide screening in a high-incidence, underserved setting
  
• Highlighting the role of community engagement in increasing screening uptake and reducing barriers to participation
  
• Demonstrating how operational planning, when informed by local knowledge and interagency collaboration, can enhance intervention effectiveness
  
• Informing future TB response strategies that centre cultural safety, community leadership, and adaptability to local realities

By emphasising trust, collaboration, and responsiveness to community needs, this work supports the broader vision of TB elimination in Nunavut and contributes to national public health goals rooted in equity and reconciliation.

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Stay tuned — publications and data visualisations related to this work will be made available here soon.

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This research is conducted in collaboration with the Government of Nunavut, reflecting a shared commitment to advancing community-led and culturally grounded approaches to tuberculosis prevention and control in northern Canada.