University of Otago researcher Professor Philip Hill was recently awarded $250,000 from the Health Research Council (HRC) to undertake a feasibility study on the best way to get rid of TB in the Māori population.

TB is the world’s leading cause of death due to an infectious disease. It is caused by bacteria that spread from person to person through microscopic droplets released into the air. This can happen when someone with the untreated, active form of tuberculosis coughs, speaks, sneezes, spits, laughs or sings.

Although it is contagious, it’s not easy to catch. Despite this, global control strategies have been unable to eliminate the disease and resistance to TB drugs is increasing. As well active TB can result in lung damage. And although New Zealand has a low rate of TB, new cases continue to occur and half of New Zealand-born TB patients are Māori.  Drug-resistant TB is now present in New Zealand also.

Hill is McAuley Professor of International Health and Co-Director of the University of Otago’s Centre for International Health. He says it is likely there is a large reservoir of dormant, or latent, TB infection in older Māori, who were previously exposed to the disease, which will continue to reactivate to cause TB disease and to infect new people.

“While we don’t know all the reasons why TB reactivates, this ‘reactivation’ can be avoided through preventive treatment. We hope that identifying and treating latent TB infection could play a major part in the elimination of TB among Māori,” Hill explains.

Hill has partnered with Associate Professor Joanne Baxter (Ngai Tahu and Ngati Apa Ki te Rā Tō), who is director of Otago’s Kōhatu Centre for Hauora Māori and with Waikato District Health Board’s Te Puna Oranga service,  which is led by Dr Nina Scott (Ngāti Whātua and Waikato).

Together, they will assess whether it is feasible to conduct a large-scale skin test survey for latent TB infection, with appropriate investigation for TB disease in those who test positive, across both urban and rural Māori in New Zealand.

“The Waikato has that good urban/rural mix, and in addition to members of the community, we hope to work with 200 inmates at Springhill Prison. Dr Scott has an excellent record in the area and we are looking forward to working with her.”

TB was lethal for Māori in the early days of colonisation and up until the middle of last century. Dr Hill explains the problematic history New Zealand has with TB in terms of whom it harmed, and who it healed.

“New Zealand was pitched to early European immigrants with tuberculosis as the country with fresh air and a healthy climate where they could heal. The more we read about it the more troubling it is. Taking into account that an understanding of how disease spread was limited in that period, we have found that once there WAS more information Europeans with tuberculosis continued to be encouraged to come to New Zealand as a good place to recover.”

The latent nature of the disease is at odds with just how active or present the disease is in the day-to-day lives of Māori whanau as a result of that history.

“When we talk to Māori we meet people who lost a mother or a sister or an aunty to the disease. This is a disease which is still very much alive in the Māori population and in their story telling, whakapapa and histories.”

This is why it is essential, explains Dr Joanne Baxter, that the study must work within a kaupapa Māori approach and for Māori to take a lead role in strategies to eliminate TB.

“We want the feasibility study to be undertaken in a way that works from a Māori perspective. We want to know the best way to support people to participate  in the study in a way that ensures that participant mana is upheld. There are a lot of things that need to be done to respect, and to make sure the research project respects, Māori people’s preferences and needs”.

Professor Hill hopes the study will be the first step towards characterising the reservoir of latent TB infection among Māori so strategic intervention with preventive treatment can be considered.

“This is the first time in a long time that a study of this nature has been done. The only other time a study like this was undertaken was in a community on the East Coast in the 1930s. It would be good to follow that study up as part of this work.”

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