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Int J Tuberc Lung Dis. 2014 Aug;18(8):899-904. doi: 10.5588/ijtld.14.0007.

Mass treatment to eliminate tuberculosis from an island population.

Author information

1
<label>*</label>Centre for International Health, Department of Preventive and Social Medicine, Faculty of Medicine, University of Otago, Dunedin, New Zealand;
2
<label><sup>†</sup></label>HIV/AIDS, Tuberculosis, Malaria & Neglected Tropical Diseases Cluster, World Health Organization, Geneva, Switzerland;
3
<label><sup>‡</sup></label>Public Health Division, Secretariat of the Pacific Community, Noumea Cedex, New Caledonia;
4
<label><sup>§</sup></label>National Tuberculosis Control Programme, Ministry of Health and Medical Services, Republic of Kiribati;
5
<label><sup>¶</sup></label>International Union Against Tuberculosis and Lung Disease, Paris, France;
6
<label>*</label>*South African Centre for Epidemiological Modelling and Analysis, Cape Town, South Africa;
7
<label><sup>††</sup></label>Médecins Sans Frontières, Brussels Operational Centre, Luxembourg, Belgium;
8
<label><sup>‡‡</sup></label>Sydney Emerging Infectious Disease and Biosecurity Institute and Centre for Research Excellence in Tuberculosis, University of Sydney, Sydney, New South Wales, Australia;

Abstract

SETTING:

The global target of tuberculosis (TB) elimination by 2050 requires new approaches. Active case finding plus mass prophylactic treatment has been disappointing. We consider mass full anti-tuberculosis treatment as an approach to TB elimination in Kiribati, a Pacific Island nation, with a persistent epidemic of high TB incidence.

OBJECTIVE:

To construct a mathematical model to predict whether mass treatment with a full course of anti-tuberculosis drugs might eliminate TB from the defined population of the Republic of Kiribati.

METHODS:

We constructed a seven-state compartmental model of the life cycle of Mycobacterium tuberculosis in which active TB disease arises from the progression of infection, reinfection, reactivation and relapse, while distinguishing infectious from non-infectious disease. We evaluated the effects of 5-yearly mass treatment using a range of parameter values to generate outcomes in uncertainty analysis.

RESULTS:

Assuming population-wide treatment effectiveness for latent tuberculous infection and active TB of ⩾90%, annual TB incidence is expected to fall sharply at each 5-yearly round of treatment, approaching elimination in two decades. The model showed that the incidence rate is sensitive to the relapse rate after successful treatment of TB.

CONCLUSION:

Mass treatment may help to eliminate TB, at least for discrete or geographically isolated populations.

PMID:
25199002
DOI:
10.5588/ijtld.14.0007
[Indexed for MEDLINE]

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