Impact of an effective multidrug-resistant tuberculosis control programme in the setting of an immature HIV epidemic: system dynamics simulation model
Impact of an effective multidrug-resistant tuberculosis control programme in the setting of an immature HIV epidemic: system dynamics simulation model
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DOI：
10.1258/0956462054679124
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发表时间：
2005-08-01
影响因子：
1.4
通讯作者：
Coker, RJ
中科院分区：
文献类型：
--
作者：
Atun, RA;Lebcir, R;Coker, RJ
这项研究试图确定一项有效的耐多药结核病控制方案(MDRTB)对在注射吸毒者(IDU)中目睹艾滋病毒爆炸性流行的人群的影响，其中MDRTB的流行率已经很高。建立了一个传播模型，代表了药物敏感结核病(DSTB)、MDRTB和艾滋病毒在俄罗斯萨马拉奥布拉斯特成年人口中传播的动态：来自结核病和艾滋病毒感染的官方报告，来自监测研究的MDRTB估计值，来自官方区域统计数据的人口数据，来自同行评议的出版物和知情估计的传播概率数据，以及政策制定者对注射吸毒者人口的估计。在330万人口中，MDRTB的高流行率，注射吸毒者中艾滋病毒的新流行，以及有效的直接观察短程疗法(DOTS)方案，该模型预测，在MDRTB治愈率较低的情况下，预计10年内死于结核病的累积死亡人数将达到6303人，其中包括来自MDRTB的1900人死亡。在MDRTB的高治愈率下，将有4465人死亡，其中包括134人死于MDRTB。10年后，MDRTB疫情对艾滋病毒感染人群的影响很小，但随着艾滋病毒疫情的成熟，影响变得很大。当模型扩展到20年时，如果MDRTB的治愈率很低，那么MDRTB的累积死亡人数会变得非常高，同样，艾滋病毒感染人群的累积死亡也会受到严重影响。在艾滋病毒流行不成熟的情况下，如果未能积极控制MDRTB，死亡人数可能会比给予有效治疗的情况高出约三分之一。随着艾滋病毒流行的成熟，如果MDRTB控制战略无效，那么MDRTB的影响就会大大增加。这些情景的流行病学起点出现在前苏联的许多地区，这一分析表明，控制MDRTB应该是一项紧迫的优先事项。
This study sought to determine the impact of an effective programme of multidrug resistant tuberculosis control (MDRTB) on a population that is witnessing an explosive HIV epidemic among injecting drug users (IDUs), where the prevalence of MDRTB is already high. A transmission model was constructed that represents the dynamics of the drug-susceptible tuberculosis (DSTB), MDRTB and HIV spread among the adult population of Samara Oblast, Russia: from official notifications of tuberculosis and of HIV infection, estimates of MDRTB derived from surveillance studies, population data from official regional statistics, data on transmission probabilities from peer-reviewed publications and informed estimates, and policy-makers' estimates of IDU populations.Two scenarios of programme effectiveness for MDRTB were modelled and run over a period of 10 years to predict cumulative deaths. In a population of 3.3 million with a high prevalence of MDRTB, an emerging epidemic of HIV among IDUs, and a functioning directly observed therapy-short course (DOTS) programme, the model predicts that under low cure rates for MDRTB the expected cumulative deaths from tuberculosis will reach 6303 deaths including 1900 deaths from MDRTB at 10 years. Under high cure rate for MDRTB 4465 deaths will occur including 134 deaths from MDRTB. At 10 years there is little impact on HIV-infected populations from the MDRTB epidemic, but as the HIV epidemic matures the impact becomes substantial. When the model is extended to 20 years cumulative deaths from MDRTB become very high if cure rates for MDRTB are low and cumulative deaths in the HIV-infected population, likewise, are profoundly affected.In the presence of an immature HIV epidemic failure to actively control MDRTB may result in approximately a third more deaths than if effective treatment is given. As the HIV epidemic matures then the impact of MDRTB grows substantially if MDRTB control strategies are ineffective. The epidemiological starting point for these scenarios is present in many regions within the former Soviet Union and this analysis suggests control of MDRTB should be an urgent priority.