Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA; Division of Global Health Equity, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.
Lancet Glob Health. 2018 Apr;6(4):e426-e435. doi: 10.1016/S2214-109X(18)30022-6. Epub 2018 Feb 19.
In high-incidence settings, recurrent disease among previously treated individuals contributes substantially to the burden of incident and prevalent tuberculosis. The extent to which interventions targeted to this high-risk group can improve tuberculosis control has not been established. We aimed to project the population-level effect of control interventions targeted to individuals with a history of previous tuberculosis treatment in a high-incidence setting.
We developed a transmission-dynamic model of tuberculosis and HIV in a high-incidence setting with a population of roughly 40 000 people in suburban Cape Town, South Africa. The model was calibrated to data describing local demography, TB and HIV prevalence, TB case notifications and treatment outcomes using a Bayesian calibration approach. We projected the effect of annual targeted active case finding in all individuals who had previously completed tuberculosis treatment and targeted active case finding combined with lifelong secondary isoniazid preventive therapy. We estimated the effect of these targeted interventions on local tuberculosis incidence, prevalence, and mortality over a 10 year period (2016-25).
We projected that, under current control efforts in this setting, the tuberculosis epidemic will remain in slow decline for at least the next decade. Additional interventions targeted to previously treated people could greatly accelerate these declines. We projected that annual targeted active case finding combined with secondary isoniazid preventive therapy in those who previously completed tuberculosis treatment would avert 40% (95% uncertainty interval [UI] 21-56) of incident tuberculosis cases and 41% (16-55) of tuberculosis deaths occurring between 2016 and 2025.
In this high-incidence setting, the use of targeted active case finding in combination with secondary isoniazid preventive therapy in previously treated individuals could accelerate decreases in tuberculosis morbidity and mortality. Studies to measure cost and resource implications are needed to establish the feasibility of this type of targeted approach for improving tuberculosis control in settings with high tuberculosis and HIV prevalence.
National Institutes of Health, German Research Foundation.
在高发地区，先前接受过治疗的人群中出现的疾病复发对新发和现患结核病的负担有重大影响。针对这一高风险人群的干预措施在多大程度上能够改善结核病控制尚未得到证实。我们旨在预测在南非开普敦郊区一个约有 4 万人的高发地区，针对有既往结核病治疗史的人群的控制干预措施对人群的影响。
我们开发了一个结核病和 HIV 传播动力学模型，该模型基于南非开普敦郊区一个约有 40000 人的高发地区的人群。该模型通过贝叶斯校准方法，根据当地的人口统计学、TB 和 HIV 流行率、TB 病例报告和治疗结果数据进行了校准。我们预测了对所有既往完成结核病治疗的人群进行年度有针对性的主动病例发现以及将有针对性的主动病例发现与终身二级异烟肼预防性治疗相结合的效果。我们估计了这些有针对性的干预措施在未来 10 年（2016-25 年）对当地结核病发病率、患病率和死亡率的影响。
我们预测，在当前的控制努力下，在未来至少十年内，结核病流行将继续缓慢下降。针对既往治疗人群的额外干预措施可以大大加速这一下降速度。我们预测，对既往完成结核病治疗的人群进行年度有针对性的主动病例发现，并结合二级异烟肼预防性治疗，将避免 40%（95%不确定区间[UI]21-56）的新发结核病病例和 41%（16-55）的结核病死亡发生在 2016 年至 2025 年之间。
在这个高发地区，在既往治疗的人群中使用有针对性的主动病例发现，并结合二级异烟肼预防性治疗，可能会加速结核病发病率和死亡率的下降。需要进行研究以衡量成本和资源影响，以确定在结核病和 HIV 流行率较高的地区采用这种有针对性的方法改善结核病控制的可行性。
美国国立卫生研究院，德国研究基金会。
