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BMC Med. 2016 Nov 18;14(1):187.

Modelling the effect of short-course multidrug-resistant tuberculosis treatment in Karakalpakstan, Uzbekistan.

Author information

1
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. james.trauer@monash.edu.
2
The Victorian Tuberculosis Program at the Peter Doherty Institute, Melbourne, Australia. james.trauer@monash.edu.
3
Médecins sans Frontières, Manson Unit, London, UK.
4
National TB Institute, Ministry of Health, Tashkent, Uzbekistan.
5
Ministry of Health, Nukus, Uzbekistan.
6
The Victorian Tuberculosis Program at the Peter Doherty Institute, Melbourne, Australia.
7
Global TB Programme, World Health Organization, Geneva, Switzerland.
8
Médecins sans Frontières Holland, Amsterdam, The Netherlands.
9
James Cook University, Queensland, Australia.

Abstract

BACKGROUND:

Multidrug-resistant tuberculosis (MDR-TB) is a major threat to global TB control. MDR-TB treatment regimens typically have a high pill burden, last 20 months or more and often lead to unsatisfactory outcomes. A 9-11 month regimen with seven antibiotics has shown high success rates among selected MDR-TB patients in different settings and is conditionally recommended by the World Health Organization.

METHODS:

We construct a transmission-dynamic model of TB to estimate the likely impact of a shorter MDR-TB regimen when applied in a low HIV prevalence region of Uzbekistan (Karakalpakstan) with high rates of drug resistance, good access to diagnostics and a well-established community-based MDR-TB treatment programme providing treatment to around 400 patients. The model incorporates acquisition of additional drug resistance and incorrect regimen assignment. It is calibrated to local epidemiology and used to compare the impact of shorter treatment against four alternative programmatic interventions.

RESULTS:

Based on empirical outcomes among MDR-TB patients and assuming no improvement in treatment success rates, the shorter regimen reduced MDR-TB incidence from 15.2 to 9.7 cases per 100,000 population per year and MDR-TB mortality from 3.0 to 1.7 deaths per 100,000 per year, achieving comparable or greater gains than the alternative interventions. No significant increase in the burden of higher levels of resistance was predicted. Effects are probably conservative given that the regimen is likely to improve success rates.

CONCLUSIONS:

In addition to benefits to individual patients, we find that shorter MDR-TB treatment regimens also have the potential to reduce transmission of resistant strains. These findings are in the epidemiological setting of treatment availability being an important bottleneck due to high numbers of patients being eligible for treatment, and may differ in other contexts. The high proportion of MDR-TB with additional antibiotic resistance simulated was not exacerbated by programmatic responses and greater gains may be possible in contexts where the regimen is more widely applicable.

KEYWORDS:

Epidemiology; Extensively drug-resistant tuberculosis; Modelling; Multidrug-resistant tuberculosis; Public health; Treatment; Tuberculosis; Uzbekistan

PMID:
27855693
PMCID:
PMC5114735
DOI:
10.1186/s12916-016-0723-2
[Indexed for MEDLINE]
Free PMC Article

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