Epidemiological impact of targeted interventions for people with diabetes mellitus on tuberculosis transmission in India: Modelling based predictions
Epidemiological impact of targeted interventions for people with diabetes mellitus on tuberculosis transmission in India: Modelling based predictions
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DOI：
10.1016/j.epidem.2019.100381
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发表时间：
2020-03-01
期刊：
影响因子：
3.8
通讯作者：
Abu-Raddad, Laith J.
中科院分区：
文献类型：
--
作者：
Awad, Susanne F.;Critchley, Julia A.;Abu-Raddad, Laith J.
简介：糖尿病（DM）是结核病（TB）的主要驱动因素，在TB-DM负担沉重的国家。我们的目的是评估结核病的影响，针对DM在India.Methods的人的几个干预策略：以前验证的TB-DM数学模型进行了扩展，包括针对DM个人的干预措施。该模型根据年龄、糖尿病状态、结核病感染状态和阶段、结核病形式、治疗、恢复和干预状态对人群进行分层。到2050年，不同的结核病疫苗接种策略（覆盖率为50%，疫苗效力范围在50%-60%之间）将结核病发病率和死亡率降低了4. 5%-20. 8%和4. 1%-22. 1%，预防率为3.1%-12.8%。预防一个结核病病例所需的疫苗接种数量（有效性）为14-105。改变潜伏性结核病治疗的覆盖率水平（覆盖率为50%-80%，药物有效性为90%），结核病发病率和死亡率分别降低了7. 1%-11. 3%和8. 2%-13. 0%，避免了4. 2%-6. 7%的结核病病例，有效性为38-40。对结核病和糖尿病患者进行双重和同时治疗的不同方案分别使结核病发病率和死亡率降低了0.1%-0.4%和1.3%-4.8%，避免了0.1%-0.2%的结核病病例，有效性为28-107。不同的管理和控制方案（不考虑结核病状况）使结核病发病率和死亡率分别降低4.5%~ 16.5%和6.5%~ 22.2%，避免了2.9%~ 10.8%的结核病病例，有效性为6- 24。大多数策略是有效的，避免一个结核病病例所需的干预剂量< 50，为当前治疗指南的关键更新提供了信息。
Introduction: Diabetes mellitus (DM) is a leading driver of tuberculosis (TB) disease in TB-DM burdened countries. We aimed to assess the impact on TB disease of several intervention strategies targeting people with DM in India.Methods: A previously validated TB-DM mathematical model was extended to include interventions targeting DM individuals. The model stratified the population by age, DM status, TB infection status and stage, TB disease form, treatment, recovery, and intervention status.Results: By 2050, different TB vaccination strategies (coverage of 50 % and vaccine efficacies ranging between 50 %-60 %) reduced TB incidence and mortality rates by 4.5 %-20.8 % and 4.1 %-22.1 %, respectively, and averted 3.1 %-12.8 % of TB disease cases in the total population. Number of vaccinations needed to avert one TB case (effectiveness) was 14-105. Varying the coverage levels of latent TB treatment (coverage of 50 %-80 % and drug effectiveness of 90 %) reduced TB incidence and mortality rates by 7.1 %-11.3 % and 8.2 %-13.0 %, respectively, averting 4.2 %-6.7 % of TB cases, with effectiveness of 38-40. Different scenarios for dual and concurrent treatment of those with TB and DM, reduced TB incidence and mortality rates by 0.1 %-0.4 % and 1.3 %-4.8 %, respectively, averting 0.1 %-0.2 % of TB cases, with effectiveness of 28-107. Different scenarios for managing and controlling DM (regardless of TB status) reduced TB incidence and mortality rates by 4.5 %-16.5 % and 6.5 %-22.2 %, respectively, averting 2.9 %-10.8 % of TB cases, with effectiveness of 6-24.Conclusion: Gains can be attained by targeting DM individuals with interventions to reduce TB burden. Most strategies were effective with < 50 intervention doses needed to avert one TB disease case, informing key updates of current treatment guidelines.