Breaking the cycle: A community-led TB outbreak response in a remote First Nations community — The Association Specialists
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  2. Oral Presentations - Communicable disease epidemiology and action
  3. Breaking the cycle: A community-led TB outbreak response in a remote First Nations community

Breaking the cycle: A community-led TB outbreak response in a remote First Nations community (24172)

Genevieve Perrins 1 2 , Jacina Walker 1 , Mahmudul Al Imam 1 , Barbara Telfer 2 , Emma Field 2 , Guddu Kaur 2 , Gulam Khandaker 1 3
  1. Central Queensland Hospital and Health Service, Rockhampton, QLD, Australia
  2. National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
  3. National Centre for Immunisation Research and Surveillance , Sydney, NSW, Australia

Background

Tuberculosis (TB) disproportionately affects remote communities where overcrowding, limited diagnostic capacity, and under-resourced health services sustain transmission — conditions shared by First Nations communities in Australia and across the Pacific. Conventional responses anchored in contact tracing prove insufficient where transmission is widespread and community trust is fragile. In 2023, a pulmonary TB case in a remote Aboriginal community in Central Queensland was confirmed by whole-genome sequencing as part of a strain circulating since 2002. We describe the outcomes of the community-led response.

Methods

The response was co-designed with community at all stages. Authorisation from the local Aboriginal Shire Council enabled population-wide screening. Aboriginal health practitioners led all screening and engagement, providing cultural safety and trusted relationships external actors could not replicate. Community members participated in door-to-door case finding as peer advocates, reaching households inaccessible to clinic-based surveillance. Public health specialists provided technical support for community-defined priorities. A two-step IGRA protocol differentiated pre-existing latent infection from incident conversion across contact and community cohorts.

Results

Of 1,072 individuals screened, 10 active TB cases (0.9%) were identified, all genomically confirmed as a single outbreak strain. Sixty-one individuals (5.7%) were diagnosed with latent TB infection (LTBI). LTBI prevalence was comparable between close contacts (6.2%) and community members (5.4%; PR 1.13, 95% CI 0.70–1.84), supporting transmission beyond identifiable contact networks. Treatment uptake reached 90% for active cases. Community-wide screening identified 32 latent cases invisible to contact tracing.

Conclusion

Breaking the TB transmission cycle requires community governance and cultural trust alongside technical capacity. Where structural conditions sustain broad exposure, externally-led contact tracing cannot achieve the reach delivered by a community-led model. The approach we describe offers a transferable framework for remote settings facing analogous challenges, including across the Pacific. Embedding this in routine health service delivery, beyond outbreak declaration, is essential to progress toward elimination.