Public Health Network’s Guidance for Tuberculosis in Canada

Preventing the transmission of TB requires prompt diagnosis and treatment. Best practices underscore the importance of effective case management in controlling the spread of TB, from both a prevention and treatment perspective.

Because the contacts of infectious TB cases are at risk of progressing to active TB disease, investigations must be carried out in a timely and organized fashion. Best practices are documented step by step with special consideration given to maximizing existing public health resources.

Screening should be considered for groups at high risk for active TB disease or latent TB infection. With a focus on at-risk groups, best practices are drawn from proven strategies for early preventive intervention.

The collection, analysis, and interpretation of epidemiological data are essential features of public health practice. The Public Health Agency of Canada maintains a comprehensive surveillance system for active TB disease which is used by all orders of government to ensure continuous improvements in service delivery and the monitoring of disease trends and treatment outcomes over time.

The diagnosis, treatment, and prevention of TB depend on a high standard of laboratory practice. Best practices provide a blueprint for coordinating laboratory services to best support provincial and territorial TB programs.

Ensuring that healthcare providers have the training and knowledge they require to enable optimal TB prevention and control is an aspect of a successful TB program that is sometimes overlooked. Best practices point to a diverse range of educational opportunities supported by strong partnerships with educational institutions, training providers, and professional organizations.

The history of TB in Canada has had a profound impact on the beliefs, attitudes, and behaviours of Canadians most at risk for the disease. Best practices emphasize community engagement and the need to tailor awareness activities to the cultural and linguistic needs of populations at risk.

Measuring program performance is the key to ensuring that resources are being used effectively and having the intended impact. The establishment and monitoring of performance targets has been adopted as a best practice in a growing number of jurisdictions. (Appendix IV provides examples of potential TB program objectives and performance targets based on Canadian and American experience.)

In Canada, Aboriginal peoples and the foreign-born are the two populations with the highest reported rates of TB. Other at-risk groups include the homeless and residents of long-term care facilities. Best practices focus on improving detection and management of active TB disease and latent TB infection, recognizing that the approaches for addressing TB within these groups differ in a number of respects.

TB-HIV co-infection and drug-resistant TB are complicating control efforts globally. Best practices focus on internationally recognized standards for care and sources of special expertise.

It has been long understood that the burden of TB is strongly related to the social determinants of health. Best practices underscore the importance of partnerships that enhance our understanding of the non-medical factors that contribute to active TB disease and latent TB infection.

Effective TB prevention and control strategies require major investments in research and development, without which TB elimination is unlikely.