Results at a Glance: Evaluation of the Public Health Agency of Canada’s Tuberculosis Activities

Program overview

Tuberculosis (TB) is an infectious disease that disproportionately affects the poorest and most vulnerable segments of the world’s population. In Canada, rates of TB are among the lowest in the world, yet two populations, Indigenous peoples and foreign-born individuals from high-incidence countries, are disproportionally affected by persistently higher rates.

Within the Agency, TB-related activities are led by the Infectious Diseases Program Branch (IDPB). The overall objective of PHAC’s TB-related activities is to reduce the rate of TB in Canada. In line with PHAC’s core functions, IDPB is responsible for coordinating and leading the majority of PHAC’s TB-related activities, including national surveillance, policy development and coordination, awareness building, and advancing the TB response through partnerships and inter-sectoral collaboration. The work is also supported by the National Microbiology Laboratory (NML), which provides laboratory leadership, reference and diagnostic services, and support to public health partners for surveillance and control of tuberculosis in Canada. NML also aims to deliver testing support, training, and capacity building solutions directly to Northern, remote, and isolated communities affected by tuberculosis disease.

Evaluation Approach

The evaluation focused on the impact of PHAC’s TB-related activities on TB prevention and care in Canada, focusing on at-risk populations, covering the period from 2015-16 to 2020-21.

• document and file review
• literature review
• key informant interviews
• comparative analysis with other jurisdictions
• financial data review
• data analysis

What the evaluation found

PHAC has initiated a variety of useful small-scale TB initiatives in recent years to address the needs of at-risk populations. They have helped increase TB awareness and testing among Indigenous populations and migrants in high-risk communities, as well as screening for latent TB infection (LTBI) among certain categories of migrants during their immigration selection process. PHAC also documented the most effective LTBI treatments among at-risk populations. Moreover, the National Microbiology Laboratory Branch (NMLB), field epidemiologists, and public health officers’ services have significantly supported laboratories and communities across the country in addressing TB outbreaks.

Nonetheless, coordination, communication, and clarity of roles and responsibilities remain ongoing challenges, both internally and among external stakeholders, including on the international stage. Achieving TB elimination domestically calls for a centralized and shared coordination role between IDPB and NMLB. Furthermore, at the national level, there are opportunities for PHAC to lead a country-wide approach and generate synergies through pan-Canadian strategic planning, enhanced intelligence gathering, and strengthened science-based decision making.

Finally, TB-specific and broader PHAC-level challenges related to the timeliness and usefulness of surveillance of infectious diseases must be addressed to better understand and respond to at-risk population needs, to effectively monitor infectious disease trends, and to guide decision making internally and across the country. A performance measurement framework is not yet available to support decision making.

Recommendations

1. Clearly articulate and communicate PHAC’s TB role, responsibilities, and priorities.
2. Once PHAC’s roles, responsibilities and priorities are clearly articulated, the Infectious Diseases Programs Branch should establish the necessary governance structures:
   1. internally to ensure TB activities are better coordinated within the Agency; and
   2. externally to ensure TB activities are better coordinated across Canada to achieve elimination goals.
3. Update the TB surveillance approach to improve timeliness and utility, as well as to consider how LTBI could be monitored going forward.
4. Revise current performance measurement practices to effectively measure the impact of PHAC’s TB activities, including LTBI.