通过全面的社区干预实现结核病疫情的“重大转变”：基于模型的分析。
Achieving a "step change" in the tuberculosis epidemic through comprehensive community-wide intervention: a model-based analysis.
机构信息
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
Johns Hopkins School of Medicine, Baltimore, USA.
出版信息
BMC Med. 2021 Oct 14;19(1):244. doi: 10.1186/s12916-021-02110-5.
BACKGROUND
Global progress towards reducing tuberculosis (TB) incidence and mortality has consistently lagged behind the World Health Organization targets leading to a perception that large reductions in TB burden cannot be achieved. However, several recent and historical trials suggest that intervention efforts that are comprehensive and intensive can have a substantial epidemiological impact. We aimed to quantify the potential epidemiological impact of an intensive but realistic, community-wide campaign utilizing existing tools and designed to achieve a "step change" in the TB burden.
METHODS
We developed a compartmental model that resembled TB transmission and epidemiology of a mid-sized city in India, the country with the greatest absolute TB burden worldwide. We modeled the impact of a one-time, community-wide screening campaign, with treatment for TB disease and preventive therapy for latent TB infection (LTBI). This one-time intervention was followed by the strengthening of the tuberculosis-related health system, potentially facilitated by leveraging the one-time campaign. We estimated the tuberculosis cases and deaths that could be averted over 10 years using this comprehensive approach and assessed the contributions of individual components of the intervention.
RESULTS
A campaign that successfully screened 70% of the adult population for active and latent tuberculosis and subsequently reduced diagnostic and treatment delays and unsuccessful treatment outcomes by 50% was projected to avert 7800 (95% range 5450-10,200) cases and 1710 (1290-2180) tuberculosis-related deaths per 1 million population over 10 years. Of the total averted deaths, 33.5% (28.2-38.3) were attributable to the inclusion of preventive therapy and 52.9% (48.4-56.9) to health system strengthening.
CONCLUSIONS
A one-time, community-wide mass campaign, comprehensively designed to detect, treat, and prevent tuberculosis with currently existing tools can have a meaningful and long-lasting epidemiological impact. Successful treatment of LTBI is critical to achieving this result. Health system strengthening is essential to any effort to transform the TB response.
背景
全球在降低结核病（TB）发病率和死亡率方面的进展一直落后于世界卫生组织的目标，这导致人们认为无法大幅降低结核病负担。然而，最近和历史上的几项试验表明，全面和密集的干预措施可以产生重大的流行病学影响。我们旨在量化利用现有工具并旨在实现结核病负担“重大改变”的密集但现实的全社区运动的潜在流行病学影响。
方法
我们开发了一个隔室模型，该模型类似于印度一个中等城市的结核病传播和流行病学情况，印度是全球结核病负担最大的国家。我们对一次全社区筛查运动的影响进行了建模，该运动针对结核病和潜伏性结核病感染（LTBI）进行治疗。在一次干预之后，结核病相关卫生系统得到加强，这可能得益于利用一次性运动。我们使用这种综合方法估计了在 10 年内可以避免的结核病病例和死亡人数，并评估了干预措施各个组成部分的贡献。
结果
一项成功筛查了 70%的成年人口的活动性和潜伏性结核病的运动，随后将诊断和治疗延迟以及治疗失败的比例降低了 50%，预计将使每 100 万人中减少 7800 例（95%范围为 5450-10200 例）和 1710 例（1290-2180 例）结核病相关死亡。在总避免的死亡人数中，33.5%（28.2-38.3）归因于预防性治疗的纳入，52.9%（48.4-56.9）归因于卫生系统的加强。
结论
一次全面的全社区大规模运动，全面设计用于使用当前现有工具检测、治疗和预防结核病，可以产生有意义且持久的流行病学影响。成功治疗 LTBI 是实现这一结果的关键。卫生系统的加强是任何改变结核病应对措施的努力的关键。
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