Evaluating health and economic effects of targeted strategies in TB/HIV

描述(申请人提供)：艾滋病毒流行在撒哈拉以南非洲引发了结核病(TB)负担的急剧增加。一项新出现的共识表明，以被动识别患有活动性肺部疾病的个人为基础的全球结核病控制的传统战略可能不足以积极应对由艾滋病毒引发的结核病流行。因此，世界卫生组织更新了建议，作为控制艾滋病毒相关结核病流行的新战略方法的两个关键组成部分，支持更广泛地使用结核病潜伏性感染治疗和更积极地筛查结核病。到目前为止，在广泛的人口范围内测试这些策略的社区随机研究产生了令人失望的结果。我们假设，靶向使用TLTBI和活动性结核病病例发现可能比非靶向使用更有效、更具成本效益。我们在这个项目中的总体目标是使用结核病和艾滋病毒流行的数学模型来检验这一假设，并评估在设计和实施有针对性的战略时替代选择的相对有效性和效率。为了实现这一目标，我们的项目有三个具体目标：(1)开发一个详细的结核病/艾滋病毒共同流行的模拟模型，并将该模型校准到撒哈拉以南非洲的9个高负担国家。(2)利用这一模式确定有效和具有成本效益的战略，对活动性结核病进行有针对性的筛查。(3)利用这一模式确定有效和成本效益高的目标TLTBI的使用策略。数学模型可以提供一种独特的方法来整合来自现有研究的信息，以比较针对和组合筛查干预措施的替代战略的预测效果(和成本)。我们提出的模式旨在满足这一关键需求，并提供新的工具，为制定和修订部署干预措施的国家和国际战略提供信息，这些干预措施在单独和结合使用时能够最大限度地产生影响和资金效益。我们期望这项研究将为寻求确定关键优先事项并为艾滋病毒高流行环境下的结核病控制设定目标的政策制定者和研究人员提供必要的信息。除了提供证据外， 为了与政策直接相关，本研究中开发的方法将为进一步分析提供持久的模板，包括对其他有针对性或一般性的结核病控制战略的前瞻性评估；对规划的影响和成本效益的回顾评估；以及监测在资源有限的情况下实现减少结核病和艾滋病毒负担的关键目标的进展情况。

DESCRIPTION (provided by applicant): The HIV epidemic has triggered a sharp increase in the burden of tuberculosis (TB) in sub-Saharan Africa. An emerging consensus suggests that the conventional strategy for global TB control, based on passive identification of individuals with active pulmonary disease, may not be sufficiently aggressive to address HIV-fuelled TB epidemics. As a result, the World Health Organization has updated recommendations to support wider use of treatment for latent M. tuberculosis infection (TLTBI) and more active screening for TB disease, as two key components of a new strategic approach for control of HIV-associated TB epidemics. Community-randomized studies testing these strategies on a broad population-wide scale, have produced disappointing results thus far. We hypothesize that targeted use of TLTBI and active TB case-finding may prove more effective, and more cost-effective, than non-targeted use. Our overall goal in this project is to use mathematical models of TB and HIV epidemics to examine this hypothesis and evaluate the comparative effectiveness and efficiency of alternative choices in the design and implementation of targeted strategies. Toward this goal our project has three specific aims: (1) To develop a detailed simulation model of TB/HIV co-epidemics and calibrate the model to 9 high burden countries in sub-Saharan Africa. (2) To use this model to identify strategies for effective and cost-effective use of targeted screening for active tuberculosis. (3) To use this model to identify strategies for effective and cost-effective use of targeted TLTBI. Mathematical models can provide a unique approach to consolidate information from available studies to compare the projected effects (and costs) of alternative strategies for targeting and combining screening interventions. The models we propose aim to meet this critical need and supply new tools to inform development and revision of national and international strategies for deploying interventions that can maximize impact and value for money when used singly and in combination. We expect this study to provide essential information for policy makers and researchers seeking to identify key priorities and set targets for tuberculosis control in settings of high HIV prevalence. In addition to providing evidence with immediate relevance to policy, the approach developed in this study will provide a durable template for further analyses, including prospective assessment of other targeted or general TB control strategies; retrospective evaluation of the impact and cost- effectiveness of programs; and monitoring of progress towards key goals for reducing the burdens of TB and HIV in resource limited settings.