The Aurum Institute, Johannesburg, South Africa.
TB Modelling Group, TB Centre, The London School of Hygiene and Tropical Medicine, London, United Kingdom.
PLoS One. 2019 Jan 25;14(1):e0209320. doi: 10.1371/journal.pone.0209320. eCollection 2019.
South Africa has the highest tuberculosis (TB) disease incidence rate in the world, and TB is the leading infectious cause of death. Decisions on, and funding for, TB prevention and care policies are decentralised to the provincial governments and therefore, tools to inform policy need to operate at this level. We describe the use of a mathematical model planning tool at provincial level in a high HIV and TB burden country, to estimate the impact on TB burden of achieving the 90-(90)-90 targets of the Stop TB Partnership Global Plan to End TB. "TIME Impact" is a freely available, user-friendly TB modelling tool. In collaboration with provincial TB programme staff, and the South African National TB Programme, models for three (of nine) provinces were calibrated to TB notifications, incidence, and screening data. Reported levels of TB programme activities were used as baseline inputs into the models, which were used to estimate the impact of scale-up of interventions focusing on screening, linkage to care and treatment success. All baseline models predicted a trend of decreasing TB incidence and mortality, consistent with recent data from South Africa. The projected impacts of the interventions differed by province and were greatly influenced by assumed current coverage levels. The absence of provincial TB burden estimates and uncertainty in current activity coverage levels were key data gaps. A user-friendly modelling tool allows TB burden and intervention impact projection at the sub-national level. Key sub-national data gaps should be addressed to improve the quality of sub-national model predictions.
南非是世界上结核病（TB）发病率最高的国家，结核病是导致死亡的主要传染病原因。结核病预防和治疗政策的决策和资金都下放到省级政府，因此，需要在这一级别使用工具来为政策提供信息。我们描述了在一个高艾滋病毒和结核病负担的国家，在省级使用数学模型规划工具来估计实现终止结核病伙伴关系全球结核病规划的 90-（90）-90 目标对结核病负担的影响。“TIME Impact”是一个免费的、用户友好的结核病建模工具。该工具与省级结核病规划工作人员以及南非国家结核病规划合作，根据结核病通知、发病率和筛查数据对三个（九个）省份的模型进行了校准。报告的结核病规划活动水平被用作模型的基线输入，这些模型用于估计侧重于筛查、治疗关联和治疗成功的干预措施扩大规模的影响。所有基线模型都预测了结核病发病率和死亡率下降的趋势，这与南非最近的数据一致。干预措施的预计影响因省份而异，并且受到当前覆盖率水平的极大影响。省级结核病负担估计和当前活动覆盖率的不确定性是关键的数据差距。用户友好的建模工具允许在国家以下一级进行结核病负担和干预影响预测。应解决关键的国家以下一级数据差距问题，以提高国家以下一级模型预测的质量。
