Active case-finding of tuberculosis compared with symptom-driven standard of care: a modelling analysis.
Int J Epidemiol
; 53(2)2024 Feb 14.
Article
in En
| MEDLINE
| ID: mdl-38374719
ABSTRACT
BACKGROUND:
In settings with large case detection gaps, active case-finding (ACF) may play a critical role in the uberculosis (TB) response. However, ACF is resource intensive, and its effectiveness depends on whether people detected with TB through ACF might otherwise spontaneously resolve or be diagnosed through routine care. We analysed the potential effectiveness of ACF for TB relative to the counterfactual scenario of routine care alone.METHODS:
We constructed a Markov simulation model of TB natural history, diagnosis, symptoms, ACF and treatment, using a hypothetical reference setting using data from South East Asian countries. We calibrated the model to empirical data using Bayesian methods, and simulated potential 5-year outcomes with an 'aspirational' ACF intervention (reflecting maximum possible effectiveness) compared with the standard-of-care outcomes.RESULTS:
Under the standard of care, 51% (95% credible interval, CrI 31%, 75%) of people with prevalent TB at baseline were estimated to be diagnosed and linked to care over 5 years. With aspirational ACF, this increased to 88% (95% CrI 84%, 94%). Most of this difference represented people who were diagnosed and treated through ACF but experienced spontaneous resolution under standard-of-care. Aspirational ACF was projected to reduce the average duration of TB disease by 12 months (95% CrI 6%, 18%) and TB-associated disability-adjusted life-years by 71% (95% CrI 67%, 76%).CONCLUSION:
These data illustrate the importance of considering outcomes in a counterfactual standard of care scenario, as well as trade-offs between overdiagnosis and averted morbidity through earlier diagnosis-not just for TB, but for any disease in which population-based screening is recommended.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Tuberculosis
/
Standard of Care
Limits:
Humans
Country/Region as subject:
Asia
Language:
En
Journal:
Int J Epidemiol
Year:
2024
Type:
Article
Affiliation country:
United States