Assessing Control Strategies and Timelines for Mycobacterium Tuberculosis Elimination

Tuberculosis (TB) continues to inflict a disproportionate impact on Inuit communities in Canada, with reported rates of active TB that are over 300 times higher than those of Canadian-born, non-Indigenous populations. The Inuit Tuberculosis Elimination Framework aims to reduce the incidence of active TB by at least 50% by 2025, with the ultimate goal of eliminating it (i.e., reducing the incidence of active TB below 1 case per 1,000,000 population) by 2030. However, whether these goals can be achieved with the resources and interventions currently available has not been investigated.

This dissertation formulates an agent-based model (ABM) of TB transmission dynamics and control to assess the feasibility of achieving the goals of elimination framework in Nunavut, Canada. I applied the model to project the annual incidence of active TB from 2025 to 2040, taking into account factors such as time to case identification after developing active TB, contact tracing and testing, patient isolation and compliance, household size, and the potential impact of a therapeutic vaccine. In order to determine the potential reduction in TB incidence, various scenarios of treatment regimens were evaluated within the action plans for TB elimination. The scenario analyses demonstrate that the time-to-identification of active TB cases is a crucial factor in attainability of the goals, highlighting the importance of investment in early case detection. The findings also indicate that the goal of 50% reduction in annual incidence of TB by 2025 is only achievable under best case scenarios of combined interventions. However, TB elimination will likely exceed timelines indicated in the action plans.