Journal Club

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Join us for our next Journal Club session happening on February 11 at 12pm ET/ 7pm SAST/6pm CEST.
We will be discussing the following article below:
Law, S., Armstrong, G., Schwartzman, K., Campbell, J. R., Johnston, J., & Silva, D. S. (2025). Moral distress among health care workers and decision-makers undermines tuberculosis infection screening and treatment programs for migrants in Canada: a reflexive thematic analysis. BMC health services research, 26(1), 56. https://doi.org/10.1186/s12913-025-13822-2
 Email nancy.bedingfield@ucalgary.ca for more information
Canada SSHIFTB
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Background

Routine screening of new immigrants for tuberculosis (TB) infection is being adopted or considered in high-income countries with a low burden of TB disease, such as Canada, but has major ethical implications due to the excess burden of costs and risks placed on migrants. We conducted a pragmatic qualitative study to understand health care providers’ and decision-makers’ perspectives on health care access, policy and ethics associated with screening and treating TB infection among new immigrants.

Methods

Between Aug. 2023 and Feb. 2024, we conducted semi-structured interviews with 20 health care providers and public health decision-makers in five Canadian cities. We constructed themes inductively via reflexive thematic analysis of transcripts, guided by pre-existing ethical concepts in public health policy related to risk imposition and the just distribution of risk.

Findings

In the current political and health care landscape, TB providers and decision-makers who work with new immigrants and TB programs expressed experiences of moral distress due to an inability to fulfil their clinical and moral duty towards new immigrants. They attributed this to disconnected health and immigration policies, as well as high degrees of uncertainty around individual and societal benefits of an immigration-based TB infection screening program. The moral distress manifests as general reluctance among health providers to pursue TB infection screening and TPT for new immigrants.

Conclusion

The moral distress experienced by TB providers and decision-makers undermines the potential health impact of immigration-based screening. Our study highlights crucial faults within current health and immigration policies that fuel their distress, including the lack of: a ‘firewall’ between TB infection screening and the immigration process; facilitation of trust-building and informed decision-making; and reciprocity for the disproportionate burden of costs and risks placed on immigrants.

Health care workers Mental Health Canada
Publication

Key Points

  • Although tuberculosis (TB) disease is preventable and curable, it affects nearly 11 million people worldwide each year, more than 2000 of whom live in Canada.
  • In Canada, TB overwhelmingly affects Indigenous people and those born outside the country.
  • To facilitate progress to TB elimination, political will and leadership should support the implementation of 4 key solutions: creation of a national body to lead the TB response; improved availability and usability of national TB surveillance data; increased access to essential TB medications; and better funding for TB research and development both domestically and internationally.
Advocacy Canada

Zoe Omenka is a Junior Research Associate with SSHIFTB under the supervision of Dr. Amrita Daftary. She contributes to research projects through data analysis and to maintaining the SSHIFTB website.

CanadaStudent

On September 25, Yuliya Chorna, PhD candidate in Social Anthropology and SSHIFTB contributor at York University, joined the #LeadOnTB Advocacy Day on Parliament Hill in Ottawa organized by Results Canada, Partners In Health, Stop TB Canada, Médecins Sans Frontières, TBPeople Canada, TBFighters, and CAAN.

The event gathered global and Canadian advocates, health experts, and people with lived experience of Tuberculosis (TB). Participants called on Canada to step up its leadership against TB with political will and sustained investments in Budget 2025 and beyond. This urgent call is rooted in the public imagination of TB as a clear marker of social injustice. Each year, over ten million people worldwide get sick and more than a million die from this preventable and curable disease. Urging the federal government to do more to help end this deadly epidemic is more than ask for funding - it is a call for commitment to equity and global solidarity.

Canada has a proud legacy of supporting global TB efforts, including being a foundational donor of the Global Fund to Fight AIDS, Tuberculosis and Malaria and the Stop TB Partnership’s TB REACH initiative, which have helped save millions of lives around the world. At the TB Advocacy Day, civil society met with Members of Parliament and reiterated the need for sustained Canadian leadership and investment in international assistance. Key global asks included to continue an ambitious pledge to the Global Fund to Fight AIDS, Tuberculosis, and Malaria; increased funding for TB research and development; and
supporting community-led initiatives such as the Challenge Facility for Civil Society, for people most affected to drive the TB response.

Advocates also emphasized that Canadian leadership must extend to TB elimination efforts at home. While TB incidence in Canada is low overall, Inuit, First Nations, and newcomer communities are disproportionately affected. This vulnerability to TB reflects deep inequities in housing, access to care and other social determinants of health. Amplifying voices at the TB Advocacy Day, advocates called for Canada to establish a permanent, fully funded National TB Elimination Strategy. This strategy must be co-developed with First Nations, Inuit, and Métis partners to improve access to essential medicines and tackle the social conditions driving TB.

Group Photo credit: Finnigan Lin

Advocacy Canada
Publication

Tuberculosis (TB) disproportionately affects immigrants and refugees in Canada, who accounted for 80% of active TB cases in 2023 despite making up only 23% of the population. This commentary highlights the urgent need to address systemic barriers that hinder access to timely and effective TB care across the cascade, from screening and diagnosis to treatment completion. Drawing on recent policy reports and emerging evidence, this paper focuses on four main intersecting challenges: language barriers, limited cultural competency among providers, healthcare system inefficiencies, and misinformation. These barriers not only delay diagnosis, but also undermine treatment adherence and trust in the healthcare system. This commentary calls for scalable, equity-driven interventions including improved interpretation services, and tailored community-based education to TB-specific training for healthcare providers. To advance Canada's TB elimination goals, we must center the lived realities of immigrants and refugees, whilst strengthening the responsiveness, accessibility, and continuity of care within the Canadian healthcare system.

Keywords: Access to care; Canadian healthcare system; Health equity; Refugee health; Tuberculosis (TB).

Advocacy Migrant / mobile populations Canada

Lilia Scudamore is a researcher at the Indian Ocean World Centre and the Department of Equity, Ethics, and Policy at McGill University. She holds an MA in History from McGill, where her thesis explored tuberculosis policy and public healthcare funding in the early 20th-century United States. Her work also examines racialized constructions of TB in the Indian Ocean World. She has been awarded the C.C. Bayley Prize in History, the Federation for the Humanities and Social Sciences Congress Graduate Merit Award, and the Building 21 BLUE Fellowship.

Hailing from a background in history, Lilia's work contextualizes contemporary TB discourse, policy, and healthcare delivery challenges with the hope of using past insights to inform innovative research and responses today.

CanadaContributor

MSF, RESULTS, and Canada’s TB fighters are joining hands to plan a Canadian Parliament Hill Day in the fall focused on TB! The Hill Day will focus on the Global Fund pledge, contributing a fair share in TB research and development, and improving access to TB medicines domestically in Canada.

Here's a link to expressing your interest toward this effort: https://docs.google.com/forms/d/e/1FAIpQLSfPkbT55Rs_sSVcbpuoRuL7xNTLjm0aX_HJo58M2k0SeHgjZA/viewform

Date: September 24 & 25, 2025

For further updates, follow TBFighters on Instagram: https://www.instagram.com/p/DKsi_gmMcTS/

Canada

March 2025

In this issue of our newsletter, we draw your attention to a SSHIFTB World TB Day Webinar, an exclusive interview about the dogma of DOT, words with an activist impacted by the Stop-Work order, a new guidance for generating evidence on TB treatments, and our presence at the Union-NAR conference.

Read Now
Canada United States of America SSHIFTB
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UHN’s West Park Healthcare Centre has a 120-year history of providing exemplary care to tuberculosis patients. Founded in 1904 as a TB sanitorium, today West Park is the province’s designated centre for treating resistant tuberculosis and mycobacterial infections, while leading national efforts in rehabilitation.

On World TB Day 2025, West Park and Toronto Public Health invite clinicians in the TB field and public health agencies to attend their conference: “TB Horizons: Advancing Diagnosis, Treatment, and Prevention.”

Register Here

Canada
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The McGill Summer Institutes in Global Health is now accepting registrations for summer 2025. It is the 10th Anniversary of the Institute. We hope you will join us in this milestone year! As before, we are excited to run the course for Qualitative Methods in Global Infectious Disease Research.

About Qualitative Methods in Global Infectious Diseases Research | May 26-30, 2025

An introductory online course focused on the principles and rigorous application of qualitative methods in formative, operational, evaluation and policy research in infectious disease in diverse global settings.

  • Included are interactive lectures and exercises, panel discussions, guest appearances on cutting-edge topics, and mentorship from expert course faculty,
  • Suited for anyone involved in infectious disease work and with an interest in qualitative or mixed methods research, with little to no experience, e.g., clinical researchers, program managers, students and fellows, and representatives of funding, government, and community organizations.
  • Taught entirely online from 8 am to 11:30 am EST. Real-time attendance encouraged. Asynchronous participation feasible.
  • Participants are encouraged to seek support from supervisors or employers, where possible, and availability of the early bird discount (ends May 2) and tiered rates.
  • To learn more about this and other short, non-credit professional development courses running at the McGill Summer Institute please visit the Summer Institute website, Course schedule and descriptions, Registration and Pricing, and FAQ. For pending questions email the Summer Institute team.

 

Click below for more information on the course:

Qual Methods 2025

Canada

Charity Oga-Omenka, Ph.D., is an Assistant Professor at the School of Public Health and Health Systems, University of Waterloo. With a PhD in Public Health (Global Health) from the University of Montreal and over two decades of experience, her work spans the intersection of global public health, access to care, and health systems in low- and middle-income countries. Her research focuses on barriers and facilitators to healthcare access, particularly in tuberculosis (TB), HIV, and mental health care, emphasizing the impacts of social determinants of health.

Charity has held several leadership roles, including TB Centre Manager at McGill University and Program Manager at the Institute of Human Virology Nigeria. She has received numerous awards, such as the Women Leaders in Global Health award, and has secured significant research funding, including from the Bill and Melinda Gates Foundation.

As a mentor and global health advocate, she is dedicated to fostering equity in healthcare delivery, particularly in post-COVID recovery efforts. Charity's ongoing research explores innovative strategies to improve healthcare access in resource-constrained settings.

CanadaContributor

Nancy is post-doctoral TB research fellow with a strong interests in qualitative methods, patient education, health equity, and implementation science. Nancy completed her PhD from the Universtiy of Calgary in 2022 and has experience working as a TB nurse (15 years), a clinical trials project manager (7 years) and a knowledge translation project manager (1 year). Nancy is based in Canada and currently working under the supervision of Dr. Dick Menzies and Dr. Amrita Daftary. She is working on collaborative, international projects with the McGill International TB Research Centre, the Dahdaleh School of Global Health, the Tuberculosis Trials Consortium, and the Desmond Tutu Health Foundation. She initiated and is facilitating the SSHIFTB Social Science TB Journal Club.

CanadaContributor Journal Club
Publication

Background: The proportion of intense tropical cyclones is expected to increase in a changing climate. However, there is currently no consistent and comprehensive assessment of infectious disease risk following tropical cyclone exposure across countries and over decades. We aimed to explore the tropical cyclone-associated hospitalisation risks and burden for cause-specific infectious diseases on a multi-country scale.

Methods: Hospitalisation records for infectious diseases were collected from six countries and territories (Canada, South Korea, New Zealand, Taiwan, Thailand, and Viet Nam) during various periods between 2000 and 2019. The days with tropical cyclone-associated maximum sustained windspeeds of 34 knots or higher derived from a parametric wind field model were considered as tropical cyclone exposure days. The association of monthly infectious diseases hospitalisations and tropical cyclone exposure days was first examined at location level using a distributed lag non-linear quasi-Poisson regression model, and then pooled using a random-effects meta-analysis. The tropical cyclone-attributable number and fraction of infectious disease hospitalisations were also calculated.

Findings: Overall, 2·2 million people who were hospitalised for infectious diseases in 179 locations that had at least one tropical cyclone exposure day in the six countries and territories were included in the analysis. The elevated hospitalisation risks for infectious diseases associated with tropical cyclones tended to dissipate 2 months after the tropical cyclone exposure. Overall, each additional tropical cyclone day was associated with a 9% (cumulative relative risk 1·09 [95% CI 1·05-1·14]) increase in hospitalisations for all-cause infectious diseases, 13% (1·13 [1·05-1·21]) for intestinal infectious diseases, 14% (1·14 [1·05-1·23]) for sepsis, and 22% (1·22 [1·03-1·46]) for dengue during the 2 months after a tropical cyclone. Associations of tropical cyclones with hospitalisations for tuberculosis and malaria were not significant. In total, 0·72% (95% CI 0·40-1·01) of the hospitalisations for all-cause infectious diseases, 0·33% (0·15-0·49) for intestinal infectious diseases, 1·31% (0·57-1·95) for sepsis, and 0·63% (0·10-1·04) for dengue were attributable to tropical cyclone exposures. The attributable burdens were higher among young populations (aged ≤19 years) and male individuals compared with their counterparts, especially for intestinal infectious diseases. The heterogeneous spatiotemporal pattern was further revealed at the country and territory level-tropical cyclone-attributable fractions showed a decreasing trend in South Korea during the study period but an increasing trend in Viet Nam, Taiwan, and New Zealand.

Interpretation: Tropical cyclones were associated with persistent elevated hospitalisation risks of infectious diseases (particularly sepsis and intestinal infectious diseases). Targeted interventions should be formulated for different populations, regions, and causes of infectious diseases based on evidence on tropical cyclone epidemiology to respond to the increasing risk and burden.

Funding: Australian Research Council, Australian National Health, and Medical Research Council.

Climate change Comorbidities Canada
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