Department of Infectious Disease Epidemiology, St. Mary's Hospital, Imperial College, London, UK.
Public Health Foundation of India, New Delhi, India.
Indian J Med Res. 2019 Apr;149(4):517-527. doi: 10.4103/ijmr.IJMR_1901_18.
BACKGROUND & OBJECTIVES: To support recent political commitments to end tuberculosis (TB) in the World Health Organization South-East Asian Region (SEAR), there is a need to understand by what measures, and with what investment, these goals could be reached. These questions were addressed by using mathematical models of TB transmission by doing the analysis on a country-by-country basis in SEAR.
A dynamical model of TB transmission was developed, in consultation with each of the 11 countries in the SEAR. Three intervention scenarios were examined: (i) strengthening basic TB services (including private sector engagement), (ii) accelerating TB case-finding and notification, and (iii) deployment of a prognostic biomarker test by 2025, to guide mass preventive therapy of latent TB infection. Each scenario was built on the preceding ones, in successive combination.
Comprehensive improvements in basic TB services by 2020, in combination with accelerated case-finding to increase TB detection by at least two-fold by 2020, could lead to a reduction in TB incidence rates in SEAR by 67.3 per cent [95% credible intervals (CrI) 65.3-69.8] and TB deaths by 80.9 per cent (95% CrI 77.9-84.7) in 2035, relative to 2015. These interventions alone would require an additional investment of at least US$ 25 billion. However, their combined effect is insufficient to reach the end TB targets of 80 per cent by 2030 and 90 per cent by 2035. Model projections show how additionally, deployment of a biomarker test by 2025 could end TB in the region by 2035. Targeting specific risk groups, such as slum dwellers, could mitigate the coverage needed in the general population, to end TB in the Region.
INTERPRETATION & CONCLUSIONS: While the scale-up of currently available strategies may play an important role in averting TB cases and deaths in the Region, there will ultimately be a need for novel, mass preventive measures, to meet the end TB goals. Achieving these impacts will require a substantial escalation in funding for TB control in the Region.
为支持世界卫生组织东南亚区域（SEAR）最近承诺消除结核病（TB），有必要了解通过哪些措施以及需要多少投资才能实现这些目标。本研究通过对 SEAR 各国进行逐国分析，使用结核病传播的数学模型来回答这些问题。
与 SEAR 的 11 个国家进行协商后，开发了一种结核病传播的动力学模型。检查了三种干预情景：（i）加强基本结核病服务（包括私营部门的参与），（ii）加速结核病病例发现和报告，以及（iii）到 2025 年部署预后生物标志物检测，以指导潜伏性结核病感染的大规模预防性治疗。每个情景都在前一个情景的基础上，依次组合而成。
到 2020 年全面改善基本结核病服务，并结合加速病例发现，使 2020 年结核病检测至少增加两倍，到 2035 年，SEAR 的结核病发病率将降低 67.3%（95%可信区间[CrI]65.3-69.8），结核病死亡人数将降低 80.9%（95% CrI 77.9-84.7），与 2015 年相比。这些干预措施本身至少需要额外投资 250 亿美元。然而，它们的综合效果不足以实现到 2030 年达到 80%和到 2035 年达到 90%的终结结核病目标。模型预测显示，到 2025 年部署生物标志物检测如何能够在 2035 年终结该区域的结核病。针对特定的风险群体，如贫民窟居民，可以减少在普通人群中需要的覆盖范围，从而在该地区终结结核病。
虽然扩大现有策略的规模可能在避免该地区结核病病例和死亡方面发挥重要作用，但最终需要新的大规模预防措施来实现终结结核病的目标。实现这些影响将需要大幅增加该地区结核病控制的资金投入。
