Improving health system efficiency in tuberculosis prevention and control through targeted LTBI screening in the foreign-born

Project number: 
14-105
Approval date: 
Wednesday, April 1, 2015
Principal Investigator: 
Johnston,James
Institution: 
BC Centre for Disease Control (BCCDC)
Funding Agency: 
Canadian Institutes of Health Research(CIHR),Michael Smith Foundation (MSFHR),BC Centre for Disease
Datasets requested: 
Citizenship and Immigration Canada (CIC) Permanent Residents
Medical Services Plan (BC Ministry of Health)
consolidation - census geocodes
bc cancer
Deaths (BC Vital Statistics Agency)
PharmaNet
Consolidation registry (Ministry of Health)
Hospital Separations (BC Ministry of Health)
Income band (Statistics Canada)
BC Centre for Disease Control
Consolidation - demographic (Ministry of Health)
Research objective: 

RESEARCH GOAL AND OBJECTIVES

We hypothesize that certain subgroups within foreign-born populations are at higher risk for TB and can be identified based on demographic and medical risk factors.

1. Overall goal
This proposal focuses on the development and implementation of targeted, evidence-based, and cost-effective latent tuberculosis infection (LTBI) screening recommendations for the foreign-born population of BC. The evidence generated by this study will allow us to evaluate current screening guidelines and will guide decisions on the implementation of population based foreign-born LTBI screening programs across Canada.

2. Study objectives
The objectives of this study are threefold:
i. To identify specific subgroups of the foreign-born population that are at high-risk for active TB based on demographic and medical risk factors. This will include the development of a TB risk score that will quantify an individuals risk of active TB depending on demographic and medical risk factors.
ii. To determine which high-risk populations would be most cost-effective to screen and treat for LTBI from a health systems perspective (Phase 2).
iii. To implement the most cost-effective strategies across the province through a network of stakeholders, physicians and community groups by leveraging an established provincial TB strategic implementation group (Phase 3).

Publications: 

Journal Publication

  • Campbell J et al. Tuberculosis Risk in Migrants with Chronic Kidney Disease in British Columbia, Canada. The output of this study got combined with the study noted below and the reference is: Campbell, Jonathon R., et al. "Screening for Latent Tuberculosis Infection in Migrants With CKD: A Cost-effectiveness Analysis." American Journal of Kidney Diseases73.1 (2019): 39-50.
  • Ronald, Lisa A., et al. "Estimated impact of World Health Organization latent tuberculosis screening guidelines in a low TB incidence region: retrospective cohort study." Clinical Infectious Diseases (2019).
  • Campbell J et al. "Screening for Latent Tuberculosis Infection in Migrants With CKD: A Cost-effectiveness Analysis." American Journal of Kidney Diseases73.1 (2019): 39-50.
  • Ronald LA, Campbell JR, Balshaw RF, et al. Demographic predictors of active tuberculosis in people migrating to British Columbia, Canada: a retrospective cohort study. CMAJ 2018;190:E209-16.
  • Ronald LA, Campbell JR, Balshaw RF, Roth DZ, Romanowski K, Marra F, Cook VJ, Johnston JC. Predicting tuberculosis risk in the foreign-born population of British Columbia, Canada: study protocol for a retrospective population-based cohort study. BMJ Open. 2016 Nov 25;6(11):e013488

Academic thesis or dissertation

  • Campbell J. Reducing the Tuberculosis Burden in Migrant Populations through Latent Tuberculosis Infection Interventions: A Series of Cost-Effectiveness Analyses. PhD Dissertation, University of BC, successfully defended Jan 2018

Presentation of research material (poster/seminar/lecture etc.)

  • Johnston J. Impact of co-morbidities on TB epidemiology in migrants to Canada. Presented Nov 2017 to an audience outside of colleagues.
  • Balshaw, R. Causal Thinking in Statistics: Clinical Trials, Biomarkers, and Public Health. George and Fay Yee Centre for Healthcare Innovation. April 3, 2017. Winnipeg, Manitoba.
  • Johnston J. Tuberculosis Screening in the Foreign-born: the Canadian Framework. International Union of TB and Lung Disease- North America Region annual conference. February 24th, 2017. Vancouver, BC.
  • Ronald LA, Johnston J. Tuberculosis in the foreign-born population of British Columbia. BC Centre for Disease Control Grand Rounds. December 13th, 2016. Vancouver, BC

Conference abstract/presentation

  • Puyat J et al. Risk of active TB among foreign-born individuals with close contact to people with pulmonary TB. Presented at the North American Union TB conference in February 2019.
  • Rose C et al. Risk of tuberculosis in patients prescribed medical immunosuppressive treatment in British Columbia, Canada: Retrospective Cohort Study.Presented at the Union World Conference on Lung Health at The Hague, in the Netherlands (October 2018).
  • Kumar D et al. Risk of Tuberculosis in Cancer Patients in British Columbia, Canada. Presented at the Union World Conference on Lung Health at The Hague, in the Netherlands (October 2018).
  • Ronald L et al. Predictors of active tuberculosis among refugees in British Columbia, Canada: retrospective cohort study. 1st World Congress on Migration, Ethnicity, Race, and Health. Edinburgh, UK, May 201
  • Ronald L et al. Estimating the impact of World Health Organization latent tuberculosis screening and treatment guidelines on tuberculosis risk in migrants to British Columbia, Canada. 22nd IUATLD-North America Region conference, Chicago, US. February 2018
  • Ronald LA, Campbell JR, Balshaw RF, Romanowski K, Roth D, Marra F, Cook VJ, Johnston JC . Demographic predictors of active tuberculosis in migrants to British Columbia, Canada. Accepted abstract, for presentation at International Union of Tuberculosis and Lung Disease Annual Conference, Guadalajara, Mexico, October 2017.
  • Ronald LA, Campbell JR, Balshaw RF, Roth DZ, Romanowski K, Marra F, Cook VJ, Johnston JC. Predicting tuberculosis risk in the foreign-born population of British Columbia, Canada: retrospective population-based cohort study. Abstract accepted for poster presentation at 2017 American Thoracic Society International Conference, Washington, DC, May 2017.
  • Johnston J. Using data for TB prevention in migrant populations. Presented October 2016 to an audience outside of colleagues.

Page last revised: May 13, 2019