Canada is home to a large number of foreign-born people, accounting for more than 20% of the total population. Canada has a low incidence of TB, but about 70% of TB diagnoses occur among foreign-born persons. Only a minority of active TB cases among the foreign-born population are identified during post-landing surveillance programs; as a result, additional TB preventive strategies are required. The recommended approach is targeted TB infection testing and treatment that balances risks and benefits: considering the risk of prior TB exposure and of progression to active disease vs. the risk of adverse effects and the likelihood of treatment completion. Post-arrival TB infection testing and treatment are limited by substantial attrition in the care cascade. The impact of TB infection testing and treatment will be optimized among the foreign-born population if programs address patient and provider barriers and are linguistically- and culturally-sensitive.
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