Tuberculosis infection and disease in a remote aboriginal Australian community: findings from community-wide screening

Background Community-level data on tuberculosis (TB) infection and disease in remote Aboriginal communities in Australia are limited. Such data can inform locally appropriate assessment and prevention strategies. This study aimed to describe the proportion of assessed residents with TB infection, document TB disease diagnoses during a community-wide screening response, and examine factors associated with TB infection. Methods We conducted a retrospective cross-sectional analysis of data from a community-wide tuberculosis screening activity among residents of a community in the Aṉangu Pitjantjatjara Yankunytjatjara Lands, South Australia, between July 2023 and February 2024. Demographic, clinical, and social risk factor data were collected. Participants were assessed for tuberculosis infection and tuberculosis disease using standard clinical, radiological, and microbiological criteria. Multivariable logistic regression was used to examine factors associated with TB infection, excluding residents with TB disease. Results Of 770 eligible residents, 624 (81%) underwent TB screening or assessment. TB infection was identified in 47 of 614 assessed residents without TB disease (7.65%; 95% CI 5.68–10.05%). Ten eligible residents were newly diagnosed with TB disease during the study period (1.30%; 95% CI 0.62–2.38%): six through dedicated screening events and four through clinic-based assessment. Factors associated with TB infection in the adjusted analysis were age ≥ 25 years (adjusted odds ratio [aOR] 4.51; 95% CI 1.64–12.43), current or past water-pipe marijuana use (aOR 3.50; 95% CI 1.78–6.86) and close contact with an infectious TB case (aOR 3.43; 95% CI 1.62–7.25). Renal disease was associated with TB infection in unadjusted but not adjusted analysis (aOR 1.91; 95% CI 0.90–4.04). Conclusions Community-wide screening and clinical assessment identified a substantial burden of TB infection and disease in a remote Aboriginal community. The partnership between Nganampa Health Council and South Australian Tuberculosis Services combined Aboriginal leadership, community engagement and specialist expertise. The findings can inform locally adapted TB assessment and prevention that build on community strengths and support Aboriginal self-determination.