Spatially-targeted tuberculosis screening has limited impact beyond household contact tracing in Lima, Peru: A model-based analysis.
Spatially-targeted tuberculosis screening has limited impact beyond household contact tracing in Lima, Peru: A model-based analysis.
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DOI：
10.1371/journal.pone.0293519
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发表时间：
2023
期刊：
影响因子：
3.7
通讯作者：
中科院分区：
文献类型：
--
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数学模型表明，针对结核病的空间定向筛查干预措施可能有效地加速疾病控制，但支持这些发现的经验数据有限。以前的模型显示了这些干预措施的重大影响，通常模拟了大规模的筛查工作，并没有试图以高分辨率捕捉家庭和社区中结核病的空间分布。在这里，我们将基于个人的模型校准到秘鲁利马一个地区的病例通报地点。我们评估了结合家庭接触者追踪（HHCT）使用的有空间针对性的干预措施的增量效率和影响。我们的分析显示，HHCT相对有效，需要筛查40（四分位数范围：31.7至49.9）家庭接触者才能发现一例活动性结核病。然而，HHCT对人群的影响有限，5年内发病率中位数仅降低3.7%（四分位数范围：5.8%至1.9%）。相比之下，空间靶向筛查（我们将其建模为在结核病高发地区100平方米网格内发现活动性病例）的效率要低得多，需要评估约12倍于HHCT的个体数量才能发现单个活动性结核病患者。此外，在5年期间，增加有空间针对性的筛查工作仅对结核病发病率产生了适度的额外降低（≈1.3%）。总之，我们发现HHCT是一种发现结核病病例的有效方法，但对人群的影响有限。其他针对结核病高流行地区的筛查方法效率较低，除非能够筛查大量个体，否则影响可能有限。
Mathematical models have suggested that spatially-targeted screening interventions for tuberculosis may efficiently accelerate disease control, but empirical data supporting these findings are limited. Previous models demonstrating substantial impacts of these interventions have typically simulated large-scale screening efforts and have not attempted to capture the spatial distribution of tuberculosis in households and communities at a high resolution. Here, we calibrate an individual-based model to the locations of case notifications in one district of Lima, Peru. We estimate the incremental efficiency and impact of a spatially-targeted interventions used in combination with household contact tracing (HHCT). Our analysis reveals that HHCT is relatively efficient with a median of 40 (Interquartile Range: 31.7 to 49.9) household contacts required to be screened to detect a single case of active tuberculosis. However, HHCT has limited population impact, producing a median incidence reduction of only 3.7% (Interquartile Range: 5.8% to 1.9%) over 5 years. In comparison, spatially targeted screening (which we modeled as active case finding within high tuberculosis prevalence areas 100 m2 grid cell) is far less efficient, requiring evaluation of ≈12 times the number of individuals as HHCT to find a single individual with active tuberculosis. Furthermore, the addition of the spatially targeted screening effort produced only modest additional reductions in tuberculosis incidence over the 5 year period (≈1.3%) in tuberculosis incidence. In summary, we found that HHCT is an efficient approach for tuberculosis case finding, but has limited population impact. Other screening approaches which target areas of high tuberculosis prevalence are less efficient, and may have limited impact unless very large numbers of individuals can be screened.
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