Tackling tuberculosis in the indigenous people of New Zealand
Authors: Htin Lin Aung, Thomas J Devine, Claire V Mulholland, Vickery L Arcus, Gregory M Cook
Journal: The Lancet Public Health (2019)

We read with great interest the Correspondence by Zelalem Temesgen and colleagues published in the August issue of The Lancet Public Health.1Temesgen Z Cirillo DM Raviglione MC Precision medicine and public health interventions: tuberculosis as a model?.Lancet Public Health. 2019; 4: e374Summary Full Text Full Text PDF Scopus (8) Google Scholar We strongly agree that the adoption of innovative technology such as whole-genome sequencing can improve tuberculosis treatment and management. We have used whole-genome sequencing to address disparate rates of tuberculosis in New Zealand. Māori, the Indigenous people of New Zealand, have higher notification rates of tuberculosis compared with New Zealand Europeans.2Aung HL Devine TJ Reducing the burden of tuberculosis in the Māori, the Indigenous people of New Zealand.Lancet Glob Health. 2019; 7: e845Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar In addition, a New Zealand unique strain known locally as the Rangipo strain, is strongly associated with Māori, with 88% of Rangipo tuberculosis cases reported in the Māori population over the past 10 years.3Mulholland CV Ruthe A Cursons RT et al.Rapid molecular diagnosis of the Mycobacterium tuberculosis Rangipo strain responsible for the largest recurring TB cluster in New Zealand.Diagn Microbiol Infect Dis. 2017; 88: 138-140Crossref PubMed Scopus (6) Google Scholar We have done whole-genome sequencing of Rangipo strains isolated from Māori people over the past 30 years in the Waikato region of New Zealand (second highest population of Māori in New Zealand).4Stats NZ Tatauranga Aotearoa2013 Census QuickStats about Māori.http://archive.stats.govt.nz/Census/2013-census/profile-and-summary-reports/quickstats-about-maori-english.aspxDate: 2013Date accessed: August 18, 2019Google Scholar Whole-genome sequencing data suggest ongoing transmission of the Rangipo strain within the Māori population for nearly three decades. This endemic strain shows the need to identify risk factors associated with ongoing tuberculosis transmission and develop appropriate population-based preventions. In addition to incorporating new technology to fight tuberculosis inequalities, as suggested by Temesgen and colleagues, the Global Plan to End TB and the Stop TB Initiative recommend that indigenous groups are involved in the conception and development of any kind of intervention. In New Zealand, a strategy that aligns with Māori values is necessary to prevent further tuberculosis transmission in the Māori population. Māori's values have underpinned several Māori public health services and frameworks in New Zealand (He Korowai Oranga: Māori Health Strategy).5Ministry of HealthHe Korowai Oranga: Māori Health Strategy.https://www.health.govt.nz/system/files/documents/publications/mhs-english.pdfDate: 2002Date accessed: August 18, 2019Google Scholar A strategy aimed at reducing tuberculosis health disparities should incorporate the principles of partnership, participation, and protection to effectively promote and protect Māori health. This strategy should encompass collaboration with whānau (family) before and during tuberculosis treatment, and representation in decision making, culturally appropriate service delivery, and maintaining and promoting access to cultural, social, and spiritual mechanisms necessary to health. Only through the combination of new and innovative technologies alongside preventative strategies that include indigenous collaboration, valorise culture, language, and other aspects of traditional knowledge, will we be able to effectively address the tuberculosis health inequalities in Indigenous people both in New Zealand and worldwide. For more on the Stop TB Partnership see http://www.stoptb.org/global/plan/ For more on the Stop TB Partnership see http://www.stoptb.org/global/plan/ We declare no competing interests. Precision medicine and public health interventions: tuberculosis as a model?Tuberculosis provides an excellent model for how precision medicine can enhance public health through adoption of new technology and facilitation of rapid expansion at the population level. Drug-resistance is an emerging crisis for which appropriate diagnostic tools are either unavailable or inadequate. Conventional phenotypic drug-susceptibility testing can identify only low numbers of resistance mutations with a long delay from the time of tuberculosis diagnosis. Consequently, only a fraction of patients with drug-resistant tuberculosis are detected and placed on adequate treatment; ineffective or delayed treatment renders patients infectious longer and propagates the crisis. Full-Text PDF Open Access