Journal
JOURNAL OF INFECTIOUS DISEASES
Volume 216, Issue -, Pages S654-S661Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/infdis/jix320
Keywords
Tuberculosis; disease transmission; infectious; public health; prevention and control; diagnosis; infection control
Categories
Funding
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Services [HHSN272201100001G]
- Bill and Melinda Gates Foundation
- Medical Research Council [MR/K012126/1] Funding Source: researchfish
- National Institute for Health Research [PHCS/03/01] Funding Source: researchfish
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To reduce the incidence of tuberculosis, it is insufficient to simply understand the dynamics of tuberculosis transmission. Rather, we must design and rigorously evaluate interventions to halt transmission, prioritizing those interventions most likely to achieve population-level impact. Synergy in reducing tuberculosis transmission may be attainable by combining interventions that shrink the reservoir of latent Mycobacterium tuberculosis infection (preventive therapy), shorten the time between disease onset and treatment initiation (case finding and diagnosis), and prevent transmission in key settings, such as the built environment (infection control). In evaluating efficacy and estimating population-level impact, cluster-randomized trials and mechanistic models play particularly prominent roles. Historical and contemporary evidence suggests that effective public health interventions can halt tuberculosis transmission, but an evidence-based approach based on knowledge of local epidemiology is necessary for success. We provide a roadmap for designing, evaluating, and modeling interventions to interrupt the process of transmission that fuels a diverse array of tuberculosis epidemics worldwide.
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