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01-12-2021 | Tuberculosis | Research article

Achieving a “step change” in the tuberculosis epidemic through comprehensive community-wide intervention: a model-based analysis

Authors: Sourya Shrestha, Emily A. Kendall, Rebekah Chang, Roy Joseph, Parastu Kasaie, Laura Gillini, Anthony Todd Fojo, Michael Campbell, Nimalan Arinaminpathy, David W. Dowdy

Published in: BMC Medicine | Issue 1/2021

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.

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Title: Achieving a “step change” in the tuberculosis epidemic through comprehensive community-wide intervention: a model-based analysis
Authors: Sourya Shrestha
Emily A. Kendall
Rebekah Chang
Roy Joseph
Parastu Kasaie
Laura Gillini
Anthony Todd Fojo
Michael Campbell
Nimalan Arinaminpathy
David W. Dowdy
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Tuberculosis
Tuberculosis
Published in: BMC Medicine / Issue 1/2021
Electronic ISSN: 1741-7015
DOI: https://doi.org/10.1186/s12916-021-02110-5

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Springer Medicine

Achieving a “step change” in the tuberculosis epidemic through comprehensive community-wide intervention: a model-based analysis

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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