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PLoS One. 2015 May 4;10(5):e0126267. doi: 10.1371/journal.pone.0126267. eCollection 2015.

Integrating Community-Based Interventions to Reverse the Convergent TB/HIV Epidemics in Rural South Africa.

Author information

1
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States of America; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, United States of America.
2
Anderson School of Management, University of California Los Angeles, Los Angeles, CA, United States of America.
3
Department of Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, CT, United States of America.
4
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States of America; Department of Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, CT, United States of America.
5
Department of Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, CT, United States of America; Church of Scotland Hospital, Tugela Ferry, KwaZulu-Natal, South Africa.
6
Department of Biostatistics, Yale University, New Haven, CT, United States of America; Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT, United States of America; Program in Computational Biology and Informatics, Yale University, New Haven, CT, United States of America.
7
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States of America; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, United States of America; Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT, United States of America; Program in Computational Biology and Informatics, Yale University, New Haven, CT, United States of America.

Abstract

The WHO recommends integrating interventions to address the devastating TB/HIV co-epidemics in South Africa, yet integration has been poorly implemented and TB/HIV control efforts need strengthening. Identifying infected individuals is particularly difficult in rural settings. We used mathematical modeling to predict the impact of community-based, integrated TB/HIV case finding and additional control strategies on South Africa's TB/HIV epidemics. We developed a model incorporating TB and HIV transmission to evaluate the effectiveness of integrating TB and HIV interventions in rural South Africa over 10 years. We modeled the impact of a novel screening program that integrates case finding for TB and HIV in the community, comparing it to status quo and recommended TB/HIV control strategies, including GeneXpert, MDR-TB treatment decentralization, improved first-line TB treatment cure rate, isoniazid preventive therapy, and expanded ART. Combining recommended interventions averted 27% of expected TB cases (95% CI 18-40%) 18% HIV (95% CI 13-24%), 60% MDR-TB (95% CI 34-83%), 69% XDR-TB (95% CI 34-90%), and 16% TB/HIV deaths (95% CI 12-29). Supplementing these interventions with annual community-based TB/HIV case finding averted a further 17% of TB cases (44% total; 95% CI 31-56%), 5% HIV (23% total; 95% CI 17-29%), 8% MDR-TB (68% total; 95% CI 40-88%), 4% XDR-TB (73% total; 95% CI 38-91%), and 8% TB/HIV deaths (24% total; 95% CI 16-39%). In addition to increasing screening frequency, we found that improving TB symptom questionnaire sensitivity, second-line TB treatment delays, default before initiating TB treatment or ART, and second-line TB drug efficacy were significantly associated with even greater reductions in TB and HIV cases. TB/HIV epidemics in South Africa were most effectively curtailed by simultaneously implementing interventions that integrated community-based TB/HIV control strategies and targeted drug-resistant TB. Strengthening existing TB and HIV treatment programs is needed to further reduce disease incidence.

PMID:
25938501
PMCID:
PMC4418809
DOI:
10.1371/journal.pone.0126267
[Indexed for MEDLINE]
Free PMC Article
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