Dalla Lana School of Public Health

Integrating Public Health and Clinical Care: The case of TB

Course Description

Tuberculosis (TB) care is a perfect example of integrating public health and clinical care. TB is a historically deadly disease that has killed over 1/6 of the people in England in the 1900s. The Directly Observed Treatment Short-course (DOTS) has been demonstrated to be the most cost-effective treatment and control strategy in the 1970s, and then it has been promoted as a national strategy worldwide since the 1990s. TB is now a curable disease with effective treatment (i.e., cure rate over 90% for smear-positive cases, and per case medication cost less than $10). Global TB incidence rate has fallen by an average of 1.5% per year since 2000, while the TB death rate has dropped nearly in half between 1990 and 2015. On the other side, TB remains a disease of poverty, and the NO 1 killers in infectious disease (1.4 million deaths and 10.4 million new cases in 2015), and growing threats from multi-drug resistant TB, and co-infections of HIV/TB and diabetes/TB. TB is a disease of poverty and is heavily stigmatized in many cultures. The United Nations have adopted the global strategy of END TB by 2035, so what does this mean to Canada and LMICs? The relevance of this topic has increased due to the collapse of global health funding, which forces many developing countries to face tough decisions between prioritizing primary care and infectious disease programs. This course will provide an overview of tuberculosis (TB) from several perspectives, including microbiology, clinical practice, public health, and health policy. We will explore TB pathology, its epidemiology, diagnosis, treatment, and various TB programs, policies, and practices at both local and global levels. Additionally, the course will address the social, ethical, and health system challenges associated with TB prevention and care.

Course Objectives

This course aims to provide students with a solid understanding of the interactions of clinical and public health in the context of TB prevention and care. Students from the Public Health Sciences (PHS), Institute of Health Policy Management and Evaluation (IHPME), Department of Family Medicine and Community Health (DFCM), and Institute of Medical Sciences (IMS) are welcome. Students will be exposed to different study skills relevant in TB prevention and care context, such as quantitative (e.g., epidemiological, and interventional) and qualitative (e.g., social science) studies, policy evaluations, operational research and spatial analysis (geographical information system, GIS). Students will have the opportunity to learn from each other’s expertise and insights. By the end of the study, students will acquire the skills to evaluate disease control programs at local or national levels critically.

Specifically, by the end of the course, students should:

• Have a solid knowledge on the essential elements of public health approaches in disease control;
• Understand the historical evolution of TB prevention and care programs and policies in Canada;
• Understand ethical, social and health system issues in TB prevention and care and their interactions;
• Understand how different research skills can be applied in TB studies, such as cohort analysis, social science, trials, operational research, genotyping and GIS;
• Gain insights of TB prevention and care in various settings; and
• Be able to critique country TB prevention and care programs and design operational studies.

Guest Speakers: Dr. Ross Upshur, Professor, Head, Division of Clinical Public Health, DLSPH Dr. Elizabeth Rea, Associate Medical Officer, Toronto Public Health Dr. Christopher Rutty, Adjunct Professor, DLSPH and President, Health Heritage Research Services Dr. Kamran Khan, Staff Physician, St. Michael’s Hospital and Associate Professor, IHPME Dr. Robyn Lee, PhD, Assistant Professor, Dalla Lana School of Public Health Dr. I.D. Rusen, Senior Vice President, Vital Strategies/International Union Against Tuberculosis and Lung Disease Dr. Barry Pakes, Assistant Professor and Program Director, DLSPH Dr. Firdosi R. Mehta, MD, Former WHO medical officer and Adjunct Professor, DLSPH

Methods of Assessment

Participation	10%
Mid-term short critique	20%
Presentation	20%
Individual Group Essay	50%