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Fuller NM, McQuaid CF, Harker MJ, Weerasuriya CK, McHugh TD, Knight GM. Mathematical models of drug-resistant tuberculosis lack bacterial heterogeneity: A systematic review. PLoS Pathog 2024; 20:e1011574. [PMID: 38598556 PMCID: PMC11060536 DOI: 10.1371/journal.ppat.1011574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 04/30/2024] [Accepted: 03/25/2024] [Indexed: 04/12/2024] Open
Abstract
Drug-resistant tuberculosis (DR-TB) threatens progress in the control of TB. Mathematical models are increasingly being used to guide public health decisions on managing both antimicrobial resistance (AMR) and TB. It is important to consider bacterial heterogeneity in models as it can have consequences for predictions of resistance prevalence, which may affect decision-making. We conducted a systematic review of published mathematical models to determine the modelling landscape and to explore methods for including bacterial heterogeneity. Our first objective was to identify and analyse the general characteristics of mathematical models of DR-mycobacteria, including M. tuberculosis. The second objective was to analyse methods of including bacterial heterogeneity in these models. We had different definitions of heterogeneity depending on the model level. For between-host models of mycobacterium, heterogeneity was defined as any model where bacteria of the same resistance level were further differentiated. For bacterial population models, heterogeneity was defined as having multiple distinct resistant populations. The search was conducted following PRISMA guidelines in five databases, with studies included if they were mechanistic or simulation models of DR-mycobacteria. We identified 195 studies modelling DR-mycobacteria, with most being dynamic transmission models of non-treatment intervention impact in M. tuberculosis (n = 58). Studies were set in a limited number of specific countries, and 44% of models (n = 85) included only a single level of "multidrug-resistance (MDR)". Only 23 models (8 between-host) included any bacterial heterogeneity. Most of these also captured multiple antibiotic-resistant classes (n = 17), but six models included heterogeneity in bacterial populations resistant to a single antibiotic. Heterogeneity was usually represented by different fitness values for bacteria resistant to the same antibiotic (61%, n = 14). A large and growing body of mathematical models of DR-mycobacterium is being used to explore intervention impact to support policy as well as theoretical explorations of resistance dynamics. However, the majority lack bacterial heterogeneity, suggesting that important evolutionary effects may be missed.
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Affiliation(s)
- Naomi M. Fuller
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Antimicrobial Resistance Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Tuberculosis Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Christopher F. McQuaid
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Antimicrobial Resistance Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Tuberculosis Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Martin J. Harker
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Antimicrobial Resistance Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Tuberculosis Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chathika K. Weerasuriya
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Antimicrobial Resistance Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Tuberculosis Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Timothy D. McHugh
- UCL Centre for Clinical Microbiology, Division of Infection & Immunity, Royal Free Campus, University College London, London, United Kingdom
| | - Gwenan M. Knight
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Antimicrobial Resistance Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Tuberculosis Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
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2
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Brown LK, Van Schalkwyk C, De Villiers AK, Marx FM. Impact of interventions for tuberculosis prevention and care in South Africa - a systematic review of mathematical modelling studies. S Afr Med J 2023; 113:125-134. [PMID: 36876352 DOI: 10.7196/samj.2023.v113i3.16812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Substantial additional efforts are needed to prevent, find and successfully treat tuberculosis (TB) in South Africa (SA). In thepast decade, an increasing body of mathematical modelling research has investigated the population-level impact of TB prevention and careinterventions. To date, this evidence has not been assessed in the SA context. OBJECTIVE To systematically review mathematical modelling studies that estimated the impact of interventions towards the World HealthOrganization's End TB Strategy targets for TB incidence, TB deaths and catastrophic costs due to TB in SA. METHODS We searched the PubMed, Web of Science and Scopus databases for studies that used transmission-dynamic models of TB in SAand reported on at least one of the End TB Strategy targets at population level. We described study populations, type of interventions andtheir target groups, and estimates of impact and other key findings. For studies of country-level interventions, we estimated average annualpercentage declines (AAPDs) in TB incidence and mortality attributable to the intervention. RESULTS We identified 29 studies that met our inclusion criteria, of which 7 modelled TB preventive interventions (vaccination,antiretroviral treatment (ART) for HIV, TB preventive treatment (TPT)), 12 considered interventions along the care cascade for TB(screening/case finding, reducing initial loss to follow-up, diagnostic and treatment interventions), and 10 modelled combinationsof preventive and care-cascade interventions. Only one study focused on reducing catastrophic costs due to TB. The highest impactof a single intervention was estimated in studies of TB vaccination, TPT among people living with HIV, and scale-up of ART. Forpreventive interventions, AAPDs for TB incidence varied between 0.06% and 7.07%, and for care-cascade interventions between 0.05%and 3.27%. CONCLUSION We describe a body of mathematical modelling research with a focus on TB prevention and care in SA. We found higherestimates of impact reported in studies of preventive interventions, highlighting the need to invest in TB prevention in SA. However, studyheterogeneity and inconsistent baseline scenarios limit the ability to compare impact estimates between studies. Combinations, rather thansingle interventions, are likely needed to reach the End TB Strategy targets in SA.
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Affiliation(s)
- L K Brown
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Cape Town, South Africa.
| | - C Van Schalkwyk
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Cape Town, South Africa.
| | - A K De Villiers
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Cape Town, South Africa; Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - F M Marx
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Cape Town, South Africa; Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Division of Infectious Disease and Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany.
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You X, Gu J, Xu DR, Huang S, Xue H, Hao C, Ruan Y, Sylvia S, Liao J, Cai Y, Peng L, Wang X, Li R, Li J, Hao Y. Impact of the gate-keeping policies of China's primary healthcare model on the future burden of tuberculosis in China: a protocol for a mathematical modelling study. BMJ Open 2021; 11:e048449. [PMID: 34433597 PMCID: PMC8390147 DOI: 10.1136/bmjopen-2020-048449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION In the past three decades, China has made great strides in the prevention and treatment of tuberculosis (TB). However, the TB burden remains high. In 2019, China accounted for 8.4% of global incident cases of TB, the third highest in the world, with a higher prevalence in rural areas. The Healthy China 2030 highlights the gate-keeping role of primary healthcare (PHC). However, the impact of PHC reforms on the future TB burden is unclear. We propose to use mathematical models to project and evaluate the impacts of different gate-keeping policies. METHODS AND ANALYSIS We will develop a deterministic, population-level, compartmental model to capture the dynamics of TB transmission within adult rural population. The model will incorporate seven main TB statuses, and each compartment will be subdivided by service providers. The parameters involving preference for healthcare seeking will be collected using discrete choice experiment (DCE) method. We will solve the deterministic model numerically over a 20-year (2021-2040) timeframe and predict the TB prevalence, incidence and cumulative new infections under the status quo or various policy scenarios. We will also conduct an analysis following standard protocols to calculate the average cost-effectiveness for each policy scenario relative to the status quo. A numerical calibration analysis against the available published TB prevalence data will be performed using a Bayesian approach. ETHICS AND DISSEMINATION Most of the data or parameters in the model will be obtained based on secondary data (eg, published literature and an open-access data set). The DCE survey has been reviewed and approved by the Ethics Committee of the School of Public Health, Sun Yat-sen University. The approval number is SYSU [2019]140. Results of the study will be disseminated through peer-reviewed journals, media and conference presentations.
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Affiliation(s)
- Xinyi You
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jing Gu
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Sun Yat-Sen Global Health Institute, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Dong Roman Xu
- ACACIA Labs, Institute for Global Health and School of Health Management, Southern Medical University, Guangzhou, Guangdong, China
| | - Shanshan Huang
- Centre for Tuberculosis Control of Guangdong Province, Guangzhou, Guangdong, China
| | - Hao Xue
- Stanford Center on China's Economy and Institutions, Stanford University, Stanford, California, USA
| | - Chun Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Sun Yat-Sen Global Health Institute, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yunzhou Ruan
- Department of Tuberculosis Resistance Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Sean Sylvia
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Jing Liao
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yiyuan Cai
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Department of Epidemiology and Medical Statistics, School of Public Health, Guizhou Medical University, Guiyang, Guizhou, China
| | - Liping Peng
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xiaohui Wang
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Renzhong Li
- Department of Tuberculosis Resistance Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jinghua Li
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Sun Yat-Sen Global Health Institute, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yuantao Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Sun Yat-Sen Global Health Institute, Sun Yat-Sen University, Guangzhou, Guangdong, China
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López L, Keynan Y, Marin D, Ríos-Hincapie CY, Montes F, Escudero-Atehortua AC, Rueda ZV. Is tuberculosis elimination a feasible goal in Colombia by 2050? Health Policy Plan 2020; 35:47-57. [PMID: 31665295 DOI: 10.1093/heapol/czz122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2019] [Indexed: 11/13/2022] Open
Abstract
Colombia has an underreporting of 30% of the total cases, according to World Health Organization (WHO) estimations. In 2016, successful tuberculosis (TB) treatment rate was 70%, and the mortality rate ranged between 3.5% and 10%. In 2015, Colombia adopted and adapted the End TB strategy and set a target of 50% reduction in incidence and mortality by 2035 compared with 2015. The aims of this study were: To evaluate whether Colombia will be able to achieve the goals of TB incidence and mortality by 2050, using the current strategies; and whether the implementation of new screening, diagnosis and TB treatment strategies will allow to achieve those WHO targets. An ecological study was conducted using TB case-notification, successful treatment and mortality rates from the last 8 years (2009-17). System dynamics analysis was performed using simulated scenarios: (1) continuation with the same trends following the trajectory of the last 8 years (Status quo) and (2) modification of the targets between 2017 through 2050, assuming the implementation of multimodal strategies to increase the screening, to improve the early diagnosis and to improve the treatment adherence. Following the current strategies, it is projected that Colombia will not achieve the End TB strategy targets. Achieving the goal of TB incidence of 10/100 000 by 2050 will only be possible by implementing combined strategies for increasing screening of people with respiratory symptoms, improving access to rapid diagnostic tests and improving treatment adherence. Therefore, it is necessary to design and implement simultaneous strategies according to the population needs and resources, in order to stride towards the End TB targets.
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Affiliation(s)
- Lucelly López
- Research Department Facultad de Medicina, Universidad Pontificia Bolivariana, Calle 78B # 72A-109, Medellín, Colombia
| | - Yoav Keynan
- Department of Medical Microbiology and Infectious Disease, University of Manitoba, Winnipeg, Canada.,Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.,Department of Community Health Science, University of Manitoba, Winnipeg, Canada
| | - Diana Marin
- Research Department Facultad de Medicina, Universidad Pontificia Bolivariana, Calle 78B # 72A-109, Medellín, Colombia
| | | | | | | | - Zulma Vanessa Rueda
- Research Department Facultad de Medicina, Universidad Pontificia Bolivariana, Calle 78B # 72A-109, Medellín, Colombia
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Sousa GJB, Garces TS, Pereira MLD, Moreira TMM, Silveira GMD. Temporal pattern of tuberculosis cure, mortality, and treatment abandonment in Brazilian capitals. Rev Lat Am Enfermagem 2019; 27:e3218. [PMID: 31826160 PMCID: PMC6896801 DOI: 10.1590/1518-8345.3019.3218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 08/15/2019] [Indexed: 12/02/2022] Open
Abstract
Objective: to analyze the temporal pattern of tuberculosis cure, mortality, treatment abandonment in Brazilian capitals. Method: this is an ecological study whose data source was the Information System of Notifiable Diseases for Tuberculosis (Sistema de Informação de Agravos de Notificação para Tuberculose). For analysis of temporal evolution, regressions by join points were performed considering the annual percentage variation and the significance of the trend change with 95% confidence interval. Results: 542,656 cases of tuberculosis were found, with emphasis on a 3% decrease per year in the cure rate for Campo Grande (interval: −5.0 - −0.9) and a 3.5% increase for Rio de Janeiro (interval: 1.9 - 4.7). Regarding abandonment, it decreased 10.9% per year in Rio Branco (interval: −15.8 - −5.7) and increased 12.8% per year in Fortaleza (interval: 7.6 - 18.3). For mortality, a decreasing or stationary tendency was identified, with a greater decrease (7.8%) for Porto Velho (interval:−11.0 - −5.0) and a lower one (2.5%) in Porto Alegre (interval:−4.5 - −0.6). Conclusion: the rates of cure and abandonment are far from the ones recommended by the World Health Organization, showing that Brazilian capitals need interventions aimed at changing this pattern.
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Affiliation(s)
- George Jó Bezerra Sousa
- Universidade Estadual do Ceará, Departamento de Enfermagem, Fortaleza, CE, Brazil.,Bolsista da Fundação Cearense de Apoio ao Desenvolvimento Científico e Tecnológico, Fortaleza, CE, Brazil
| | - Thiago Santos Garces
- Universidade Estadual do Ceará, Departamento de Enfermagem, Fortaleza, CE, Brazil.,Bolsista da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | | | | | - Germana Maria da Silveira
- Universidade Estadual do Ceará, Departamento de Enfermagem, Fortaleza, CE, Brazil.,Bolsista da Fundação Cearense de Apoio ao Desenvolvimento Científico e Tecnológico, Fortaleza, CE, Brazil
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6
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Kerschberger B, Schomaker M, Telnov A, Vambe D, Kisyeri N, Sikhondze W, Pasipamire L, Ngwenya SM, Rusch B, Ciglenecki I, Boulle A. Decreased risk of HIV-associated TB during antiretroviral therapy expansion in rural Eswatini from 2009 to 2016: a cohort and population-based analysis. Trop Med Int Health 2019; 24:1114-1127. [PMID: 31310029 PMCID: PMC6852273 DOI: 10.1111/tmi.13290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES This paper assesses patient- and population-level trends in TB notifications during rapid expansion of antiretroviral therapy in Eswatini which has an extremely high incidence of both TB and HIV. METHODS Patient- and population-level predictors and rates of HIV-associated TB were examined in the Shiselweni region in Eswatini from 2009 to 2016. Annual population-level denominators obtained from projected census data and prevalence estimates obtained from population-based surveys were combined with individual-level TB treatment data. Patient- and population-level predictors of HIV-associated TB were assessed with multivariate logistic and multivariate negative binomial regression models. RESULTS Of 11 328 TB cases, 71.4% were HIV co-infected and 51.8% were women. TB notifications decreased fivefold between 2009 and 2016, from 1341 to 269 cases per 100 000 person-years. The decline was sixfold in PLHIV vs. threefold in the HIV-negative population. Main patient-level predictors of HIV-associated TB were recurrent TB treatment (adjusted odds ratio [aOR] 1.40, 95% confidence interval [CI]: 1.19-1.65), negative (aOR 1.31, 1.15-1.49) and missing (aOR 1.30, 1.11-1.53) bacteriological status and diagnosis at secondary healthcare level (aOR 1.18, 1.06-1.33). Compared with 2009, the probability of TB decreased for all years from 2011 (aOR 0.69, 0.58-0.83) to 2016 (aOR 0.54, 0.43-0.69). The most pronounced population-level predictor of TB was HIV-positive status (adjusted incidence risk ratio 19.47, 14.89-25.46). CONCLUSIONS This high HIV-TB prevalence setting experienced a rapid decline in TB notifications, most pronounced in PLHIV. Achievements in HIV-TB programming were likely contributing factors.
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Affiliation(s)
- Bernhard Kerschberger
- Médecins Sans Frontières (Operational Centre Geneva)MbabaneEswatini
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Michael Schomaker
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
- Institute of Public HealthMedical Decision Making and HealthTechnology Assessment, UMIT - University for Health Sciences, Medical Informatics and TechnologyHall in TirolAustria
| | - Alex Telnov
- Médecins Sans Frontières (Operational Centre Geneva)GenevaSwitzerland
| | - Debrah Vambe
- National TB Control ProgramMinistry of HealthManziniEswatini
| | - Nicholas Kisyeri
- Eswatini National AIDS ProgrammeMinistry of HealthMbabaneEswatini
| | | | | | | | - Barbara Rusch
- Médecins Sans Frontières (Operational Centre Geneva)GenevaSwitzerland
| | - Iza Ciglenecki
- Médecins Sans Frontières (Operational Centre Geneva)GenevaSwitzerland
| | - Andrew Boulle
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
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Space-time clustering of recently-diagnosed tuberculosis and impact of ART scale-up: Evidence from an HIV hyper-endemic rural South African population. Sci Rep 2019; 9:10724. [PMID: 31341191 PMCID: PMC6656755 DOI: 10.1038/s41598-019-46455-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 06/28/2019] [Indexed: 12/26/2022] Open
Abstract
In HIV hyperendemic sub-Saharan African communities, particularly in southern Africa, the likelihood of achieving the Sustainable Development Goal of ending the tuberculosis (TB) epidemic by 2030 is low, due to lack of cost-effective and practical interventions in population settings. We used one of Africa’s largest population-based prospective cohorts from rural KwaZulu-Natal Province, South Africa, to measure the spatial variations in the prevalence of recently-diagnosed TB disease, and to quantify the impact of community coverage of antiretroviral therapy (ART) on recently-diagnosed TB disease. We collected data on TB disease episodes from a population-based sample of 41,812 adult individuals between 2009 and 2015. Spatial clusters (‘hotspots’) of recently-diagnosed TB were identified using a space-time scan statistic. Multilevel logistic regression models were fitted to investigate the relationship between community ART coverage and recently-diagnosed TB. Spatial clusters of recently-diagnosed TB were identified in a region characterized by a high prevalence of HIV and population movement. Every percentage increase in ART coverage was associated with a 2% decrease in the odds of recently-diagnosed TB (aOR = 0.98, 95% CI:0.97–0.99). We identified for the first time the clear occurrence of recently-diagnosed TB hotspots, and quantified potential benefit of increased community ART coverage in lowering tuberculosis, highlighting the need to prioritize the expansion of such effective population interventions targeting high-risk areas.
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Chanda-Kapata P, Kapata N, Klinkenberg E, Grobusch MP, Cobelens F. The prevalence of HIV among adults with pulmonary TB at a population level in Zambia. BMC Infect Dis 2017; 17:236. [PMID: 28356081 PMCID: PMC5372321 DOI: 10.1186/s12879-017-2345-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/25/2017] [Indexed: 11/26/2022] Open
Abstract
Background Tuberculosis and HIV co-infection is one of the main drivers of poor outcome for both diseases in Zambia. HIV infection has been found to predict TB infection/disease and TB has been reported as a major cause of death among individuals with HIV. Improving case detection of TB/HIV co-infection has the potential to lead to early treatment of both conditions and can impact positively on treatment outcomes. This study was conducted in order to determine the HIV prevalence among adults with tuberculosis in a national prevalence survey setting in Zambia, 2013–2014. Methods A countrywide cross sectional survey was conducted in 2013/2014 using stratified cluster sampling, proportional to population size for rural and urban populations. Each of the 66 countrywide clusters represented one census supervisory area with cluster size averaging 825 individuals. Socio-demographic characteristics were collected during a household visit by trained survey staff. A standard symptom-screening questionnaire was administered to 46,099 eligible individuals across all clusters, followed by chest x-ray reading for all eligible. Those symptomatic or with x-ray abnormalities were confirmed or ruled out as TB case by either liquid culture or Xpert MTBRif performed at the three central reference laboratories. HIV testing was offered to all participants at the survey site following the national testing algorithm with rapid tests. The prevalence was expressed as the proportion of HIV among TB cases with 95% confidence limits. Results A total of 265/6123 (4.3%) participants were confirmed of having tuberculosis. Thirty-six of 151 TB survey cases who accepted HIV testing were HIV-seropositive (23.8%; 95% CI 17.2–31.4). The mean age of the TB/HIV cases was 37.6 years (range 24–70). The majority of the TB/HIV cases had some chest x-ray abnormality (88.9%); were smear positive (50.0%), and/or had a positive culture result (94.4%). None of the 36 detected TB/HIV cases were already on TB treatment, and 5/36 (13.9%) had a previous history of TB treatment. The proportion of TB/HIV was higher in urban than in the rural clusters. The HIV status was unknown for 114/265 (43.0%) of the TB cases. Conclusions The TB/HIV prevalence in the general population was found to be lower than what is routinely reported as incident TB/HIV cases at facility level. However; the TB/HIV co-infection was higher in areas with higher TB prevalence. Innovative and effective strategies for ensuring TB/HIV co-infected individuals are detected and treated early are required.
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Affiliation(s)
- Pascalina Chanda-Kapata
- Department of Disease Surveillance and Research, Ministry of Health, Lusaka, Zambia. .,Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
| | - Nathan Kapata
- Department of Disease Surveillance and Research, Ministry of Health, Lusaka, Zambia.,Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Eveline Klinkenberg
- KNCV Tuberculosis Foundation, The Hague, the Netherlands.,Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Frank Cobelens
- KNCV Tuberculosis Foundation, The Hague, the Netherlands.,Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
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9
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Menzies NA, Gomez GB, Bozzani F, Chatterjee S, Foster N, Baena IG, Laurence YV, Qiang S, Siroka A, Sweeney S, Verguet S, Arinaminpathy N, Azman AS, Bendavid E, Chang ST, Cohen T, Denholm JT, Dowdy DW, Eckhoff PA, Goldhaber-Fiebert JD, Handel A, Huynh GH, Lalli M, Lin HH, Mandal S, McBryde ES, Pandey S, Salomon JA, Suen SC, Sumner T, Trauer JM, Wagner BG, Whalen CC, Wu CY, Boccia D, Chadha VK, Charalambous S, Chin DP, Churchyard G, Daniels C, Dewan P, Ditiu L, Eaton JW, Grant AD, Hippner P, Hosseini M, Mametja D, Pretorius C, Pillay Y, Rade K, Sahu S, Wang L, Houben RMGJ, Kimerling ME, White RG, Vassall A. Cost-effectiveness and resource implications of aggressive action on tuberculosis in China, India, and South Africa: a combined analysis of nine models. Lancet Glob Health 2016; 4:e816-e826. [PMID: 27720689 PMCID: PMC5527122 DOI: 10.1016/s2214-109x(16)30265-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 08/05/2016] [Accepted: 08/26/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND The post-2015 End TB Strategy sets global targets of reducing tuberculosis incidence by 50% and mortality by 75% by 2025. We aimed to assess resource requirements and cost-effectiveness of strategies to achieve these targets in China, India, and South Africa. METHODS We examined intervention scenarios developed in consultation with country stakeholders, which scaled up existing interventions to high but feasible coverage by 2025. Nine independent modelling groups collaborated to estimate policy outcomes, and we estimated the cost of each scenario by synthesising service use estimates, empirical cost data, and expert opinion on implementation strategies. We estimated health effects (ie, disability-adjusted life-years averted) and resource implications for 2016-35, including patient-incurred costs. To assess resource requirements and cost-effectiveness, we compared scenarios with a base case representing continued current practice. FINDINGS Incremental tuberculosis service costs differed by scenario and country, and in some cases they more than doubled existing funding needs. In general, expansion of tuberculosis services substantially reduced patient-incurred costs and, in India and China, produced net cost savings for most interventions under a societal perspective. In all three countries, expansion of access to care produced substantial health gains. Compared with current practice and conventional cost-effectiveness thresholds, most intervention approaches seemed highly cost-effective. INTERPRETATION Expansion of tuberculosis services seems cost-effective for high-burden countries and could generate substantial health and economic benefits for patients, although substantial new funding would be required. Further work to determine the optimal intervention mix for each country is necessary. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Nicolas A Menzies
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA; Center for Health Decision Science, Harvard T H Chan School of Public Health, Boston, MA, USA.
| | - Gabriela B Gomez
- Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands; Department of Global Health, Academic Medical Center, University of Amsterdam, Netherlands; Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Fiammetta Bozzani
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Nicola Foster
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Yoko V Laurence
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Sun Qiang
- School of Health Care Management and Key Laboratory of Health Economics and Policy Research of Ministry of Health, Shandong University, Jinan, China
| | | | - Sedona Sweeney
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Nimalan Arinaminpathy
- Public Health Foundation of India, Delhi NCR, India; Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Andrew S Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eran Bendavid
- Department of Medicine, Stanford University, Stanford, CA, USA
| | | | - Ted Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Justin T Denholm
- Victorian Tuberculosis Program at the Peter Doherty Institute, Melbourne, VIC, Australia; Department of Microbiology and Immunology, University of Melbourne, Melbourne, VIC, Australia
| | - David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Jeremy D Goldhaber-Fiebert
- Stanford Health Policy, Centers for Health Policy and Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | - Andreas Handel
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA
| | - Grace H Huynh
- Institute for Disease Modeling, Seattle, WA, USA; Synthetic Neurobiology Group, Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Marek Lalli
- TB Modelling Group, TB Centre, London School of Hygiene & Tropical Medicine, London, UK; Faculty of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Hsien-Ho Lin
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | | | - Emma S McBryde
- Victorian Tuberculosis Program at the Peter Doherty Institute, Melbourne, VIC, Australia; Department of Microbiology and Immunology, University of Melbourne, Melbourne, VIC, Australia; Burnet Institute, Melbourne, VIC, Australia
| | | | - Joshua A Salomon
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA; Center for Health Decision Science, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Sze-Chuan Suen
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
| | - Tom Sumner
- TB Modelling Group, TB Centre, London School of Hygiene & Tropical Medicine, London, UK; Faculty of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London, UK
| | - James M Trauer
- Victorian Tuberculosis Program at the Peter Doherty Institute, Melbourne, VIC, Australia; Department of Microbiology and Immunology, University of Melbourne, Melbourne, VIC, Australia; Burnet Institute, Melbourne, VIC, Australia
| | | | - Christopher C Whalen
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA
| | - Chieh-Yin Wu
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Delia Boccia
- Faculty of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Vineet K Chadha
- Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, India
| | | | | | - Gavin Churchyard
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; Aurum Institute, Johannesburg, South Africa; School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | | | - Puneet Dewan
- Bill & Melinda Gates Foundation, New Delhi, India
| | | | - Jeffrey W Eaton
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Alison D Grant
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; School of Public Health, University of Witwatersrand, Johannesburg, South Africa; Africa Centre for Population Health, School of Nursing & Public Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - Mehran Hosseini
- Strategic Information Department, The Global Fund, Geneva, Switzerland
| | - David Mametja
- National Department of Health, Pretoria, South Africa
| | | | - Yogan Pillay
- National Department of Health, Pretoria, South Africa
| | - Kiran Rade
- World Health Organization Country Office for India, New Delhi, India
| | | | - Lixia Wang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Rein M G J Houben
- TB Modelling Group, TB Centre, London School of Hygiene & Tropical Medicine, London, UK; Faculty of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Richard G White
- TB Modelling Group, TB Centre, London School of Hygiene & Tropical Medicine, London, UK; Faculty of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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