The Global Expansion of LTBI Screening and Treatment Programs: Exploring Gaps in the Supporting Economic Evidence.
The Global Expansion of LTBI Screening and Treatment Programs: Exploring Gaps in the Supporting Economic Evidence.
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DOI：
10.3390/pathogens12030500
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发表时间：
2023-03-22
期刊：
影响因子：
--
通讯作者：
Zwerling A
中科院分区：
文献类型：
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作者：
Kota NT;Shrestha S;Kashkary A;Samina P;Zwerling A
潜伏性结核感染（LTBI）的全球负担和LTBI向活动性结核病的进展是持续结核病发病率的重要驱动因素。通过筛查和结核病预防性治疗（TPT）解决LTBI对于到2035年结束结核病流行至关重要。鉴于世界各国卫生部门在抗击结核病方面可用的资源有限，我们必须考虑LTBI筛查和治疗策略的经济证据，以确保有限的资源用于实现最大的健康影响。在这篇叙述性综述中，我们探讨了不同人群中LTBI筛查和TPT策略的关键经济学证据，以总结我们目前的理解并突出现有知识的差距。在考虑支持LTBI筛查或评估不同检测方法的经济学证据时，在高收入国家（HIC）进行了不成比例的经济学研究，尽管绝大多数结核病负担由低收入和中等收入国家（LMIC）承担。近年来出现了时间上的转变，来自低收入和中等收入国家（LMIC）的数据越来越多，特别是在针对高危人群进行结核病预防方面。虽然LTBI筛查和预防计划可能会带来高昂的成本，但针对高危人群（如艾滋病毒感染者（PLHIV），儿童，家庭接触者（HHC）和来自高结核病负担国家的移民）的LTBI筛查已被证明可以持续提高筛查计划的成本效益。此外，不同LTBI筛查算法和诊断方法的成本效益在不同环境中差异很大，导致不同的国家结核病筛查政策。新的缩短方案TPT也一直被证明是具有成本效益的一系列设置。这些经济评估强调了关键的实施考虑因素，例如确保高依从性和完成率的关键性，尽管与依从性计划相关的成本没有进行常规评估和纳入。目前正在评估数字和其他依从性支持方法与新型缩短TPT方案的效用和成本效益，但需要更多的经济证据来了解潜在的成本节约，特别是在常规进行直接观察预防性治疗（DOPT）的环境中。尽管最近LTBI筛查和TPT的经济证据基础有所增长，但围绕扩大和实施扩展的LTBI筛查和治疗计划的经济证据仍然存在显着差距，特别是在传统上难以接触的人群中。
The global burden of latent TB infection (LTBI) and the progression of LTBI to active TB disease are important drivers of ongoing TB incidence. Addressing LTBI through screening and TB preventive treatment (TPT) is critical in order to end the TB epidemic by 2035. Given the limited resources available to health ministries around the world in the fight against TB, we must consider economic evidence for LTBI screening and treatment strategies to ensure that limited resources are used to achieve the biggest health impact. In this narrative review, we explore key economic evidence around LTBI screening and TPT strategies in different populations to summarize our current understanding and highlight gaps in existing knowledge. When considering economic evidence supporting LTBI screening or evaluating different testing approaches, a disproportionate number of economic studies have been conducted in high-income countries (HICs), despite the vast majority of TB burden being borne in low- and middle-income countries (LMICs). Recent years have seen a temporal shift, with increasing data from low- and middle-income countries (LMICs), particularly with regard to targeting high-risk groups for TB prevention. While LTBI screening and prevention programs can come with extensive costs, targeting LTBI screening among high-risk populations, such as people living with HIV (PLHIV), children, household contacts (HHC) and immigrants from high-TB-burden countries, has been shown to consistently improve the cost effectiveness of screening programs. Further, the cost effectiveness of different LTBI screening algorithms and diagnostic approaches varies widely across settings, leading to different national TB screening policies. Novel shortened regimens for TPT have also consistently been shown to be cost effective across a range of settings. These economic evaluations highlight key implementation considerations such as the critical nature of ensuring high rates of adherence and completion, despite the costs associated with adherence programs not being routinely assessed and included. Digital and other adherence support approaches are now being assessed for their utility and cost effectiveness in conjunction with novel shortened TPT regimens, but more economic evidence is needed to understand the potential cost savings, particularly in settings where directly observed preventive therapy (DOPT) is routinely conducted. Despite the growth of the economic evidence base for LTBI screening and TPT recently, there are still significant gaps in the economic evidence around the scale-up and implementation of expanded LTBI screening and treatment programs, particularly among traditionally hard-to-reach populations.
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影响因子：
7.3
作者：
Carranza C;Pedraza-Sanchez S;de Oyarzabal-Mendez E;Torres M
通讯作者：
Torres M
DOI：
10.1093/cid/ciaa857
发表时间：
2021-11-02
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
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作者：
Jo Y;Shrestha S;Gomes I;Marks S;Hill A;Asay G;Dowdy D
通讯作者：
Dowdy D
影响因子：
28.2
作者：
Capocci, Santino J.;Sewell, Janey;Lipman, Marc C., I
通讯作者：
Lipman, Marc C., I
影响因子：
--
作者：
de Perio, Marie A.;Tsevat, Joel;Eckman, Mark H.
通讯作者：
Eckman, Mark H.
影响因子：
4.5
作者：
通讯作者：
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