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Lancet Glob Health. 2018 Apr;6(4):e426-e435. doi: 10.1016/S2214-109X(18)30022-6. Epub 2018 Feb 19.

Tuberculosis control interventions targeted to previously treated people in a high-incidence setting: a modelling study.

Author information

1
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA; Division of Global Health Equity, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa. Electronic address: fmarx@sun.ac.za.
2
Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.
3
Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
4
Interfaculty Initiative in Health Policy, Harvard University, Cambridge, MA, USA.
5
Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
6
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.

Abstract

BACKGROUND:

In high-incidence settings, recurrent disease among previously treated individuals contributes substantially to the burden of incident and prevalent tuberculosis. The extent to which interventions targeted to this high-risk group can improve tuberculosis control has not been established. We aimed to project the population-level effect of control interventions targeted to individuals with a history of previous tuberculosis treatment in a high-incidence setting.

METHODS:

We developed a transmission-dynamic model of tuberculosis and HIV in a high-incidence setting with a population of roughly 40 000 people in suburban Cape Town, South Africa. The model was calibrated to data describing local demography, TB and HIV prevalence, TB case notifications and treatment outcomes using a Bayesian calibration approach. We projected the effect of annual targeted active case finding in all individuals who had previously completed tuberculosis treatment and targeted active case finding combined with lifelong secondary isoniazid preventive therapy. We estimated the effect of these targeted interventions on local tuberculosis incidence, prevalence, and mortality over a 10 year period (2016-25).

FINDINGS:

We projected that, under current control efforts in this setting, the tuberculosis epidemic will remain in slow decline for at least the next decade. Additional interventions targeted to previously treated people could greatly accelerate these declines. We projected that annual targeted active case finding combined with secondary isoniazid preventive therapy in those who previously completed tuberculosis treatment would avert 40% (95% uncertainty interval [UI] 21-56) of incident tuberculosis cases and 41% (16-55) of tuberculosis deaths occurring between 2016 and 2025.

INTERPRETATION:

In this high-incidence setting, the use of targeted active case finding in combination with secondary isoniazid preventive therapy in previously treated individuals could accelerate decreases in tuberculosis morbidity and mortality. Studies to measure cost and resource implications are needed to establish the feasibility of this type of targeted approach for improving tuberculosis control in settings with high tuberculosis and HIV prevalence.

FUNDING:

National Institutes of Health, German Research Foundation.

PMID:
29472018
PMCID:
PMC5849574
DOI:
10.1016/S2214-109X(18)30022-6
[Indexed for MEDLINE]
Free PMC Article

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