Speeding up TB diagnosis in Nunavut

Inuit organizations have led the way to much faster detection of tuberculosis in Nunavut, using a rapid molecular test recommended by the World Health Organization for TB-endemic areas internationally. Serendipitously, the new technology also made it possible for COVID testing to be done within Nunavut during the pandemic.

Experts call this “reverse innovation” – using healthcare practices and technologies from the Global South in the Global North. “What we’re now starting to discover is that there is a very rich pipeline, especially of affordable innovation, that’s coming from the developing world,” Dr. Peter Singer, CEO of Grand Challenges Canada, told the National Post in 2014.

Part of that reverse innovation has involved identifying at least two frugal and practical solutions that can be applied to health care in Nunavut – the GeneXpert/Xpert® MTB/RIF test for TB that WHO endorsed for TB-endemic countries in 2010, and a much faster test for childhood diarrhea developed in Botswana by David Goldfarb using funding from Grand Challenges Canada that can also be used in Nunavut.

The new ‘while you wait’ test incorporated modern DNA technology that could be used outside of conventional laboratories and being fully automated, was easy and safe to use, WHO said in 2010. Nunavut Tunngavik and the Nunavut government arranged for a study to be done in Iqaluit’s Qikiqtani General Hospital between March 2012 and March 2014 with funding from the Canadian Institutes of Health Research to see if it could be used in Nunavut.

Given that tuberculosis is a public health crisis among Inuit living in Inuit Nunangat, with rates of active TB being 38 times the rate for Canada as a whole, “we were interested in finding out if it would be possible to use this new technology at the hospital in Iqaluit, Nunavut and whether it would shorten the time it takes to diagnose TB patients so they can get treatment faster,” said NTI. “This technology could have an important role in improving health equity in TB diagnosis in remote, high burden regions of Canada.”

The Nunavut Xpert Study concluded in 2015 that “GeneXpert, can dramatically reduce the time it takes to diagnose and begin treating tuberculosis for patients in Nunavut”, according to Dr. Gonzalo Alvarez, a respirologist at The Ottawa Hospital and professor at the University of Ottawa. He worked on the study with Madhukar Pai, an associate professor at McGill University and researcher at the Research Institute of the McGill University Health Centre, in partnership with the Government of Nunavut and Nunavut Tunngavik Inc..

In 2012, Dr. Gonzalo Alvarez explains how the Qikiqtani General Hospital’s new GeneXpert machine works to then-federal Health Minister Leona Aglukkaq during a March 22 tour of the hospital’s laboratory. Nunatsiaq News.

Innovation and new technologies “can make a difference in remote places,” Alvarez said. He calls it a lab in a box. “It’s cases like this, and in remote settings with no on-site TB testing capacity, where GeneXpert can make the greatest difference,” said Pai, an associate director at the McGill International TB Centre. Before GeneXpert/Xpert® MTB/RIF, all samples had to be flown to the southern Canada for testing, delaying the start of treatment.

Having the GeneXpert test units in Iqaluit and Rankin Inlet (and also in Kuujjuaq and Puvirnituq in Nunavik) also came in handy for rapid testing during the COVID pandemic. Previously, those test results were taking around a week to come back from southern labs.

Using GeneXpert machines for COVID-19 testing is largely the same process as for TB, said Michael Loeffelholz, senior director of medical affairs for Cepheid, at a webinar hosted by the McGill University International TB Centre. GeneXpert machines detect the virus that causes COVID-19 through respiratory samples from oral and nasal swabs, providing results in about 45 minutes.Tuberculosis and COVID-19 testing can take place at the same time in the machine so the battle against TB doesn’t have to take a backseat, he said.

Canada’s plan to eliminate tuberculosis in Inuit communities, the Inuit Tuberculosis Elimination Framework, focuses on reducing poverty as well as improving health care. In 2018, Inuit Tapiriit Kanatami (ITK) — the national organization representing Inuit — and federal Minister of Indigenous Services Jane Philpott announced six priorities for the framework. ITK and the federal government have vowed to cut tuberculosis cases by half in Inuit communities by 2025, with the goal of fully eliminating the disease by 2030.


Nunavut Xpert Study. Taima TB project overview.

Ottawa doctor says new TB test making difference in Nunavut. Ottawa Citizen, Mar. 23, 2015.

Third World Lessons in healthcare: How ‘reverse innovation’ could revolutionize Canada’s medical landscape. National Post, Mar. 1, 2014

Poverty reduction and prevention part of TB elimination plan for Inuit communities. CBC News, Dec. 10, 2018

In-territory diagnostics ready in Nunavut with GeneXpert in Rankin Inlet. CBC, May 21, 2020

Nunavut, Nunavik roll out rapid testing for COVID-19. Nunatsiaq News, Apr. 30, 2020

Cover image: USAID Indonesia, Wikimedia