TB Modelling Group, TB Centre, London School of Hygiene and Tropical Medicine, London, UK; Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK.
Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA.
Lancet Glob Health. 2016 Nov;4(11):e806-e815. doi: 10.1016/S2214-109X(16)30199-1. Epub 2016 Oct 6.
The post-2015 End TB Strategy proposes targets of 50% reduction in tuberculosis incidence and 75% reduction in mortality from tuberculosis by 2025. We aimed to assess whether these targets are feasible in three high-burden countries with contrasting epidemiology and previous programmatic achievements.
11 independently developed mathematical models of tuberculosis transmission projected the epidemiological impact of currently available tuberculosis interventions for prevention, diagnosis, and treatment in China, India, and South Africa. Models were calibrated with data on tuberculosis incidence and mortality in 2012. Representatives from national tuberculosis programmes and the advocacy community provided distinct country-specific intervention scenarios, which included screening for symptoms, active case finding, and preventive therapy.
Aggressive scale-up of any single intervention scenario could not achieve the post-2015 End TB Strategy targets in any country. However, the models projected that, in the South Africa national tuberculosis programme scenario, a combination of continuous isoniazid preventive therapy for individuals on antiretroviral therapy, expanded facility-based screening for symptoms of tuberculosis at health centres, and improved tuberculosis care could achieve a 55% reduction in incidence (range 31-62%) and a 72% reduction in mortality (range 64-82%) compared with 2015 levels. For India, and particularly for China, full scale-up of all interventions in tuberculosis-programme performance fell short of the 2025 targets, despite preventing a cumulative 3·4 million cases. The advocacy scenarios illustrated the high impact of detecting and treating latent tuberculosis.
Major reductions in tuberculosis burden seem possible with current interventions. However, additional interventions, adapted to country-specific tuberculosis epidemiology and health systems, are needed to reach the post-2015 End TB Strategy targets at country level.
Bill and Melinda Gates Foundation.
2015 年后终结结核病策略提出，到 2025 年，结核病发病率降低 50%，结核病死亡率降低 75%。本研究旨在评估这一目标在三个具有不同流行病学特征和以往规划成就的高负担国家是否可行。
我们使用 11 种独立开发的结核病传播数学模型，对中国、印度和南非目前可用于结核病预防、诊断和治疗的干预措施的流行病学影响进行预测。模型以 2012 年结核病发病率和死亡率的数据进行校准。来自国家结核病规划和宣传界的代表提供了具有国家特色的不同干预方案，其中包括症状筛查、主动发现病例和预防性治疗。
任何单一干预方案的激进推广都无法实现 2015 年后终结结核病策略的目标。然而，模型预测，在南非国家结核病规划方案中，连续对接受抗逆转录病毒治疗的个体进行异烟肼预防性治疗、在卫生中心扩大基于设施的结核病症状筛查、以及改善结核病护理，与 2015 年水平相比，发病率可降低 55%（范围 31%至 62%），死亡率可降低 72%（范围 64%至 82%）。对于印度，尤其是中国，尽管可以预防 340 万例结核病病例，但全面推广结核病规划中的所有干预措施，仍无法达到 2025 年的目标。宣传方案说明了发现和治疗潜伏性结核病的巨大影响。
当前的干预措施似乎可以大幅降低结核病负担。然而，需要针对具体国家的结核病流行病学和卫生系统的额外干预措施，以在国家层面实现 2015 年后终结结核病策略的目标。
比尔及梅琳达·盖茨基金会。
