Achieving a "step change" in the tuberculosis epidemic through comprehensive community-wide intervention: a model-based analysis.
BMC Med
; 19(1): 244, 2021 10 14.
Article
in En
| MEDLINE
| ID: mdl-34645429
ABSTRACT
BACKGROUND:
Global progress towards reducing tuberculosis (TB) incidence and mortality has consistently lagged behind the World Health Organization targets leading to a perception that large reductions in TB burden cannot be achieved. However, several recent and historical trials suggest that intervention efforts that are comprehensive and intensive can have a substantial epidemiological impact. We aimed to quantify the potential epidemiological impact of an intensive but realistic, community-wide campaign utilizing existing tools and designed to achieve a "step change" in the TB burden.METHODS:
We developed a compartmental model that resembled TB transmission and epidemiology of a mid-sized city in India, the country with the greatest absolute TB burden worldwide. We modeled the impact of a one-time, community-wide screening campaign, with treatment for TB disease and preventive therapy for latent TB infection (LTBI). This one-time intervention was followed by the strengthening of the tuberculosis-related health system, potentially facilitated by leveraging the one-time campaign. We estimated the tuberculosis cases and deaths that could be averted over 10 years using this comprehensive approach and assessed the contributions of individual components of the intervention.RESULTS:
A campaign that successfully screened 70% of the adult population for active and latent tuberculosis and subsequently reduced diagnostic and treatment delays and unsuccessful treatment outcomes by 50% was projected to avert 7800 (95% range 5450-10,200) cases and 1710 (1290-2180) tuberculosis-related deaths per 1 million population over 10 years. Of the total averted deaths, 33.5% (28.2-38.3) were attributable to the inclusion of preventive therapy and 52.9% (48.4-56.9) to health system strengthening.CONCLUSIONS:
A one-time, community-wide mass campaign, comprehensively designed to detect, treat, and prevent tuberculosis with currently existing tools can have a meaningful and long-lasting epidemiological impact. Successful treatment of LTBI is critical to achieving this result. Health system strengthening is essential to any effort to transform the TB response.Key words
Full text:
1
Database:
MEDLINE
Main subject:
Tuberculosis
/
Latent Tuberculosis
/
Epidemics
Type of study:
Diagnostic_studies
/
Incidence_studies
/
Prognostic_studies
Limits:
Adult
/
Humans
Country/Region as subject:
Asia
Language:
En
Journal:
BMC Med
Journal subject:
MEDICINA
Year:
2021
Type:
Article
Affiliation country:
United States