Strategies for Reducing Incidence of Tuberculosis Disease in a Low-Burden Setting

• Author / Creator

  Heffernan, Courtney

• Pulmonary tuberculosis (TB) is a communicable disease that has an airborne route of transmission. It is a disease of poverty that exists in every country of the world. Within high-income, low TB burden settings, the disease increasingly affects vulnerable and underserved population groups who are hard to reach. In tandem, as TB becomes rarer, expertise in diagnosing and managing the disease declines. These two facts threaten TB elimination efforts because the delayed diagnosis of pulmonary TB can lead to transmission. Transmission can cause primary disease, or a latent TB infection (LTBI) that without appropriate precautions can reactivate at a later date, thereby causing future transmission. As such, within high-income countries already adept at identifying contacts and offering prophylaxis, it is making timelier diagnoses of pulmonary TB to interrupt transmission that is crucial. This work focuses on strategies aimed at improving current programming efforts in a high-income setting. The studies presented herein: 1) characterize the most infectious cases, with implications for raising clinical suspicion among all providers, 2) show that it is possible to ‘predict’ pulmonary TB among a cohort of people referred for TB services on the basis of readily available information from a targeted medical history, and, 3) identify a significant point of contact with the healthcare setting for undiagnosed pulmonary TB patients (the emergency department). This latter study suggests that, once validated, prediction algorithms for pulmonary TB may provide diagnostic tools that would have great application in settings where TB is frequently overlooked.

• Subjects / Keywords

  • Public Health
  • Tuberculosis
  • Clinical Epidemiology

• Graduation date

  Spring 2020

• Type of Item

  Thesis

• Degree

  Doctor of Philosophy

• DOI

  https://doi.org/10.7939/r3-60h5-jt85

• License

  Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.