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

描述（由申请人提供）：艾滋病毒的流行引发了撒哈拉以南非洲地区结核病负担的急剧增加。一项正在形成的共识表明，基于被动识别活动性肺病患者的传统全球结核病控制战略可能不足以应对由艾滋病毒引起的结核病流行。因此，世界卫生组织更新了建议，以支持更广泛地使用潜伏结核分枝杆菌感染治疗和更积极地筛查结核病，这是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。社区随机研究在广泛的人口范围内测试了这些策略，迄今为止产生了令人失望的结果。我们假设有针对性地使用TLTBI和主动结核病病例发现可能比非有针对性地使用更有效，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)开发结核病/艾滋病毒共同流行的详细模拟模型，并将该模型校准到撒哈拉以南非洲的9个高负担国家。(2)利用该模型确定有效且具有成本效益的活动性结核病靶向筛查策略。(3)利用该模型确定有效且具有成本效益的针对性TLTBI使用策略。数学模型可以提供一种独特的方法来整合现有研究的信息，以比较针对和组合筛查干预措施的替代策略的预计效果（和成本）。我们提出的模型旨在满足这一关键需求，并提供新的工具，为制定和修订国家和国际干预措施战略提供信息，这些干预措施可以在单独使用和组合使用时最大限度地发挥影响和物有所值。我们期望这项研究能为政策制定者和研究人员提供必要的信息，以便在艾滋病毒高流行的环境中确定关键优先事项和设定结核病控制目标。除了提供证据之外

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.