Tuberculosis control interventions targeted to previously treated people in a high-incidence setting : a modelling study

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dc.contributor.authorMarx, Florian M.en_ZA
dc.contributor.authorYaesoubi, Rezaen_ZA
dc.contributor.authorMenzies, Nicolas A.en_ZA
dc.contributor.authorSalomon, Joshua A.en_ZA
dc.contributor.authorBilinski, Alyssaen_ZA
dc.contributor.authorBeyers, Nuldaen_ZA
dc.contributor.authorCohen, Teden_ZA
dc.date.accessioned2020-04-29T20:15:55Z
dc.date.available2020-04-29T20:15:55Z
dc.date.issued2018-02-19
dc.descriptionCITATION: Marx, F. M., et al. 2018. Tuberculosis control interventions targeted to previously treated people in a high-incidence setting : a modelling study. The Lancet Global Health, 6(4):e426-e435, doi:10.1016/S2214-109X(18)30022-6.
dc.descriptionThe original publication is available at https://www.thelancet.com
dc.description.abstractBackground In high-incidence settings, recurrent disease among previously treated individuals contributes substantially to the burden of incident and prevalent tuberculosis. The extent to which interventions targeted to this high-risk group can improve tuberculosis control has not been established. We aimed to project the population-level effect of control interventions targeted to individuals with a history of previous tuberculosis treatment in a high-incidence setting. Methods We developed a transmission-dynamic model of tuberculosis and HIV in a high-incidence setting with a population of roughly 40 000 people in suburban Cape Town, South Africa. The model was calibrated to data describing local demography, TB and HIV prevalence, TB case notifications and treatment outcomes using a Bayesian calibration approach. We projected the effect of annual targeted active case finding in all individuals who had previously completed tuberculosis treatment and targeted active case finding combined with lifelong secondary isoniazid preventive therapy. We estimated the effect of these targeted interventions on local tuberculosis incidence, prevalence, and mortality over a 10 year period (2016–25). Findings We projected that, under current control efforts in this setting, the tuberculosis epidemic will remain in slow decline for at least the next decade. Additional interventions targeted to previously treated people could greatly accelerate these declines. We projected that annual targeted active case finding combined with secondary isoniazid preventive therapy in those who previously completed tuberculosis treatment would avert 40% (95% uncertainty interval [UI] 21–56) of incident tuberculosis cases and 41% (16–55) of tuberculosis deaths occurring between 2016 and 2025. Interpretation In this high-incidence setting, the use of targeted active case finding in combination with secondary isoniazid preventive therapy in previously treated individuals could accelerate decreases in tuberculosis morbidity and mortality. Studies to measure cost and resource implications are needed to establish the feasibility of this type of targeted approach for improving tuberculosis control in settings with high tuberculosis and HIV prevalence.en_ZA
dc.description.urihttps://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30022-6/fulltext
dc.description.versionPublisher's version
dc.format.extent10 pagesen_ZA
dc.identifier.citationMarx, F. M., et al. 2018. Tuberculosis control interventions targeted to previously treated people in a high-incidence setting : a modelling study. The Lancet Global Health, 6(4):e426-e435, doi:10.1016/S2214-109X(18)30022-6
dc.identifier.issn2214-109X (online)
dc.identifier.otherdoi:10.1016/S2214-109X(18)30022-6
dc.identifier.urihttp://hdl.handle.net/10019.1/108501
dc.language.isoen_ZAen_ZA
dc.publisherElsevieren_ZA
dc.rights.holderAuthors retain copyrighten_ZA
dc.rights.holderAuthors retain copyright
dc.subjectTuberculosis — Preventionen_ZA
dc.subjectTuberculosis — controlen_ZA
dc.subjectTuberculosis — Treatmenten_ZA
dc.titleTuberculosis control interventions targeted to previously treated people in a high-incidence setting : a modelling studyen_ZA
dc.typeArticleen_ZA
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