Bringing Everyone to the Table: A Collaboration to Improve Public Health Screening for Newcomers

In plain language, what is your project about? What questions are you trying to answer by doing this research?

To successfully welcome newcomers to Canada into New Brunswick communities, it is important that the province’s health services can respond to their unique needs. For example, many of those immigrating to this country come from areas of the world where tuberculosis (TB), an infection, is prevalent. There are health examinations done by Immigration, Refugees and Citizenship Canada (IRCC) that screen newcomers for active TB infections, but these exams do not identify a latent TB infection – an infection that is currently inactive, but can be triggered into an active infection again by, among other things, stress.

Relocating to and settling within a new country and culture, without traditional community supports, could be stressful enough to re-activate a latent infection. This creates a potential risk for TB infections in the community. An important public health intervention adopted in this province is to find a way to identify these latent infections and treat them before they do become infectious.
 
Using an interdisciplinary approach between government, academic, clinical and non-profit collaborators, our project supports this intervention by asking two main questions:

1. What are the knowledge, attitudes, and beliefs of newcomers relating to TB testing and treatment for latent TB infection?
   
   
2. What is the cost benefit of using a new, more robust test of the immune system for TB (the interferon-gamma release assay), compared to the traditional test (tuberculin skin test), to determine latent TB infection?

 
We hope that the research, awareness, and health benefits resulting from this study will leave a lasting effect on the overall wellbeing of newcomers, and on our community as a whole.

Looking at your research team members, there are people from other departments and institutions. Have you worked together before this project?

During the 2015-2016 calendar year, Canada welcomed 15,000 new Syrian refugees. At that point, Saint John alone received 500 Syrian refugees. ​

​To support the immigration process, there was a collaboration between the province’s Primary Health Care department, who performed health assessments, and the Public Health department, who provided any required immunizations. Sponsoring agencies, such as the Saint John Young Men Christian Association (YMCA) and the Saint John Newcomers Centre (SJNC), were also involved in supporting newcomers through initial screening and immunization.
 
These initial collaborations to evaluating newcomers’ health on arrival have since expanded to include infectious disease specialists and academic researchers. The YMCA and SJNC are proud to work closely with Drs. Barker, Shamputa and Webster, and their amazing TB research team, to support this project’s recruitment and data collection.  ​

How – if at all – has the COVID-19 pandemic changed your research project and/or collaboration? 

Dr. Chola Shamputa

Dr. Duncan Webster

The first phase of this project was intended to better understand the knowledge, attitudes, and beliefs of newcomers as it related to latent TB infections. We originally proposed that both the individual and focus group interviews would be conducted in-person, but the advent of the COVID-19 pandemic required us to adjust how we would collect this information. In rethinking our data collection methods, it was important to the YMCA and the SJNC to ensure that all newcomers trust the New Brunswick health system and its processes – this project would be an integral piece in the settlement journey, and we needed to leave newcomers with a feeling of trust, safety, and security in their new home.
 
We conducted the individual interviews exclusively in a virtual setting, while the focus group discussions were only permitted in-person after instituting rigorous measures to reduce the risks associated with the spread of the coronavirus. (Even then, several people invited to participate in the focus group discussions chose to instead participate in virtual interviews, partly due to COVID-19 concerns.) It is uncertain if the outcome would have been different if all the interviews were conducted in-person.

What advice would you give to others on building a successful research collaboration?

Is everyone at the table? Health research demands an understanding of the broader determinants of health that impact both the individual and the system. This requires the engagement of key stakeholders and partners, including the individuals themselves, the community-based organizations that support them, their primary, secondary and tertiary health care providers, and health researchers. The absence of any one of these representative groups poses a threat to the integrity and value of the research being conducted.

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This project, Latent Tuberculosis Infection Screening Program for Newcomers in Southern New Brunswick using Community-led Champions, is funded by the University of New Brunswick Research Fund #NF-EXP-2020-07, as well as supported by the Saint John YMCA and the Saint John Newcomer Health Centre, research assistants and participants. The team continues to collect data and looks forward to sharing its findings. This space will be updated with references once published

Dr. Isdore Chola Shamputa                             
Department of Nursing & Health Sciences, University of New Brunswick Saint John

Dr. Duncan Webster
Division of Infectious Diseases, Dept. Medicine, Saint John Regional Hospital, Horizon Health Network
 
Dr. Kimberley Barker
Medical Officer of Health, South Region, New Brunswick Department of Health
 
Community partners:
Lina Gharbiya
Saint John Newcomers Centre
 
Melanie Burns
Saint John YMCA
 
Gillian Haycox
Saint John Community Health, Horizon Health Network