Achieving a "step change" in the tuberculosis epidemic through comprehensive community-wide intervention: a model-based analysis.
Achieving a "step change" in the tuberculosis epidemic through comprehensive community-wide intervention: a model-based analysis.
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通过全面的社区干预实现结核病流行的“阶段性变化”：基于模型的分析。
DOI：
10.1186/s12916-021-02110-5
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发表时间：
2021-10-14
期刊：
影响因子：
9.3
通讯作者：
Dowdy DW
中科院分区：
文献类型：
--
作者：
Shrestha S;Kendall EA;Chang R;Joseph R;Kasaie P;Gillini L;Fojo AT;Campbell M;Arinaminpathy N;Dowdy DW
全球在减少结核病发病率和死亡率方面的进展一直落后于世界卫生组织的目标，导致人们认为无法实现结核病负担的大幅减少。然而，最近和历史上的几项试验表明，全面和密集的干预努力可以产生重大的流行病学影响。我们的目标是量化一项密集但现实的社区范围的运动的潜在流行病学影响，该运动利用现有工具，旨在实现结核病负担的“阶跃变化”。我们开发了一个房室模型，类似于印度一个中等城市的结核病传播和流行病学，印度是世界上结核病绝对负担最大的国家。我们模拟了一次性的社区范围的筛查活动的影响，包括结核病的治疗和潜伏性结核感染（LTBI）的预防性治疗。在采取这一一次性干预措施之后，加强了结核病相关保健系统，这可能通过利用这一一次性运动得到促进。我们估计了使用这种综合方法可以在10年内避免的结核病病例和死亡，并评估了干预措施的各个组成部分的贡献。一项成功筛查70%的成年人活动性和潜伏性结核病并随后将诊断和治疗延迟和不成功的治疗结果减少50%的运动预计将在10年内避免每100万人口7800例（95%范围5450- 10200）病例和1710例（1290-2180）结核病相关死亡。在避免的死亡总数中，33.5%（28.2-38.3）归因于纳入预防性治疗，52.9%（48.4-56.9）归因于加强卫生系统。一次性、全社区的大规模运动，以现有工具全面检测、治疗和预防结核病，可以产生有意义和持久的流行病学影响。LTBI的成功治疗对于实现这一结果至关重要。加强卫生系统对于转变结核病应对措施的任何努力都至关重要。在线版本包含补充材料，可通过10.1186/s12916-021-02110-5获得。
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. 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. 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. 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. The online version contains supplementary material available at 10.1186/s12916-021-02110-5.
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影响因子：
168.9
作者：
Dye, C;Garnett, GP;Williams, BG
通讯作者：
Williams, BG
DOI：
10.1016/j.jctube.2018.04.006
发表时间：
2018-05-01
影响因子：
2
作者：
Go, Unyeong;Park, Misun;Lee, Jong-Koo
通讯作者：
Lee, Jong-Koo
影响因子：
158.5
作者：
Marks, Guy B.;Nguyen, Nhung V.;Fox, Greg J.
通讯作者：
Fox, Greg J.
影响因子：
3.7
作者：
Creswell J;Codlin AJ;Andre E;Micek MA;Bedru A;Carter EJ;Yadav RP;Mosneaga A;Rai B;Banu S;Brouwer M;Blok L;Sahu S;Ditiu L
通讯作者：
Ditiu L
DOI：
10.1073/pnas.0600349103
发表时间：
2006-05-02
影响因子：
11.1
作者：
Cohen, T;Lipsitch, M;Murray, M
通讯作者：
Murray, M