Journal
AMERICAN JOURNAL OF EPIDEMIOLOGY
Volume 181, Issue 8, Pages 619-632Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/aje/kwu320
Keywords
mass community-wide isoniazid preventive therapy; mathematical model; tuberculosis
Categories
Funding
- Consortium to Respond Effectively to the AIDS/TB Epidemic [19790.01]
- Bill and Melinda Gates Foundation [21675, OPP1084276]
- Medical Research Council (United Kingdom) [G0802414, G0700837]
- Centers for Disease Control and Prevention/President's Emergency Plan for AIDS Relief via the Aurum Institute [5U2GPS0008111]
- Wellcome Trust Research Fellowship [WT091769]
- United Kingdom Department of Health
- MRC [G0700837, G0802414, MR/K007467/1] Funding Source: UKRI
- Medical Research Council [MR/K012126/1, G0802414, MR/K007467/1, G0700837] Funding Source: researchfish
- National Institute for Health Research [PHCS/03/01] Funding Source: researchfish
Ask authors/readers for more resources
A recent major cluster randomized trial of screening, active disease treatment, and mass isoniazid preventive therapy for 9 months during 2006-2011 among South African gold miners showed reduced individual-level tuberculosis incidence but no detectable population-level impact. We fitted a dynamic mathematical model to trial data and explored 1) factors contributing to the lack of population-level impact, 2) the best-achievable impact if all implementation characteristics were increased to the highest level achieved during the trial (optimized intervention), and 3) how tuberculosis might be better controlled with additional interventions (improving diagnostics, reducing treatment delay, providing isoniazid preventive therapy continuously to human immunodeficiency virus-positive people, or scaling up antiretroviral treatment coverage) individually and in combination. We found the following: 1) The model suggests that a small proportion of latent infections among human immunodeficiency virus-positive people were cured, which could have been a key factor explaining the lack of detectable population-level impact. 2) The optimized implementation increased impact by only 10%. 3) Implementing additional interventions individually and in combination led to up to 30% and 75% reductions, respectively, in tuberculosis incidence after 10 years. Tuberculosis control requires a combination prevention approach, including health systems strengthening to minimize treatment delay, improving diagnostics, increased antiretroviral treatment coverage, and effective preventive treatment regimens.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available