Modelling the potential impact of adherence technologies on tuberculosis in India
Modelling the potential impact of adherence technologies on tuberculosis in India
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DOI：
10.5588/ijtld.19.0472
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发表时间：
2020-05-01
影响因子：
4
通讯作者：
Dewan, P.
中科院分区：
文献类型：
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作者：
Arinaminpathy, N.;Chin, D. P.;Dewan, P.
背景：对于接受标准一线结核病治疗的患者，缺少10%或更多的剂量会使复发风险增加6倍。数字技术为结核病患者的依从性支持提供了新的途径。我们估计了新的粘附技术在印度的潜在影响。方法：我们在印度建立了一个结核病传播动力学的数学模型，捕捉了遗漏剂量和治疗默认对治疗后复发的独立影响。我们模拟了干预措施的影响，以解决公共和私营医疗保健部门的遗漏剂量和治疗违约问题。结果：依从性干预措施，如果仅在公共部门进行优化部署，将在2020年至2030年期间将累计结核病发病率降低7.3%(95%可信区间[CrI] 4.7-11)，如果在私营部门也进行部署，将降低16%（95%可信区间[CrI] 11-23）。这种影响大致与干预措施的有效性成正比。减少漏给剂量可使发病率降低12% (95% CrI 7.0-18)，而减少治疗默认可使发病率降低7.9% （95% CrI 3.2-13）。结论：减少漏给剂量至少与促进治疗完成同等重要。我们的研究结果表明，提高治疗依从性的新兴技术可能对印度的结核病发病率和死亡率产生重大影响。
BACKGROUND: For patients taking standard first-line tuberculosis treatment, missing 10% or more of their doses increases the risk of relapse six-fold. Digital technologies offer new approaches to adherence support for TB patients. We estimated the potential impact of new adherence technologies in India.METHOD: We developed a mathematical model of TB transmission dynamics in India, capturing the independent effects of missed doses and treatment default on post-treatment recurrence. We simulated the impact of interventions to address both missed doses and treatment default in the public and private healthcare sector.RESULTS: Adherence interventions, if deployed optimally in the public sector alone, would reduce cumulative TB incidence by 7.3% (95% credible intervals [CrI] 4.7-11) between 2020 and 2030, and by 16% (95% CrI 11-23) if also deployed in the private sector. This impact is roughly proportional to the effectiveness of the interventions. Reducing missed doses reduced incidence by 12% (95% CrI 7.0-18), while reducing treatment default reduced incidence by 7.9% (95% CrI 3.2-13).CONCLUSION: Minimising missed doses is at least as important as promoting treatment completion. Our results suggest that emerging technologies to improve treatment adherence could have a substantial impact on TB incidence and mortality in India.