Department of Biology.
Center for Population Health Sciences, Division of Primary Care and Population Health, Department of Medicine.
AIDS. 2018 Sep 24;32(15):2129-2140. doi: 10.1097/QAD.0000000000001959.
We model the epidemiological impact of providing isoniazid preventive therapy (IPT) to South African adolescents, among whom HIV prevalence is low, latent tuberculosis (TB) prevalence is high, and school-based programs may enable population-level coverage.
We simulate a dynamic compartmental model of age-structured HIV and TB coepidemics in South Africa. HIV dynamics are modeled by infection status, CD4 cell count, and antiretroviral therapy; TB dynamics are modeled by disease stage, diagnosis, treatment, and IPT status. We analyze the effects of continuous IPT coverage among adolescents from 5 (baseline) to 90%.
Our model is calibrated to WHO and the Joint United Nations Programme on HIV/AIDS epidemiological estimates. In simulations, increasing IPT coverage to 50% among adolescents reduced active TB incidence by 5-34%. Increasing coverage to 90% led to a 9-40% reduction in active TB incidence. Expanded IPT access causes TB incidence to decline in the general population of HIV-positive individuals, as well as in adult HIV-positive individuals.
Targeting IPT to a secondary school population with high latent TB prevalence and low-HIV prevalence, in which risk of false-negative diagnosis of active TB is low and IPT benefits are more established, could have substantial benefits to adolescents and spillover benefits to the adult population.
我们构建了模型，以评估在南非青少年中开展异烟肼预防性治疗（IPT）的流行病学影响。南非的青少年中 HIV 流行率低，潜伏性结核病（TB）流行率高，而学校为基础的项目可能实现人群层面的覆盖率。
我们通过感染状态、CD4 细胞计数和抗逆转录病毒疗法来模拟南非年龄结构 HIV 和 TB 共流行的动态分组模型；通过疾病阶段、诊断、治疗和 IPT 状态来模拟 TB 动态。我们分析了从 5 岁（基线）到 90 岁的青少年连续接受 IPT 覆盖率的影响。
我们的模型经过了世界卫生组织和联合国艾滋病规划署的流行病学估计值的校准。在模拟中，将青少年的 IPT 覆盖率从 50%增加到 90%，可使活动性 TB 发病率降低 9%至 40%。扩大 IPT 可及性会导致 HIV 阳性个体以及成人 HIV 阳性个体的 TB 发病率下降。
IPT 针对潜伏性 TB 流行率高、HIV 流行率低的中学人群，假阴性诊断活动性 TB 的风险低，IPT 的获益更明确，这可能会对青少年产生重大影响，并对成年人群产生溢出效应。
