Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA; Center for Health Decision Science, Harvard T H Chan School of Public Health, Boston, MA, USA.
Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
Lancet Public Health. 2024 Aug;9(8):e573-e582. doi: 10.1016/S2468-2667(24)00150-6.
For settings with low tuberculosis incidence, disease elimination is a long-term goal. We investigated pathways to tuberculosis pre-elimination (incidence <1·0 cases per 100 000 people) and elimination (incidence <0·1 cases per 100 000 people) in the USA, where incidence was estimated at 2·9 per 100 000 people in 2023.
Using a mathematical modelling framework, we simulated how US tuberculosis incidence could be affected by changes in tuberculosis services in the countries of origin for future migrants to the USA, as well as changes in tuberculosis services inside the USA. To do so, we used a linked set of transmission dynamic models, calibrated to demographic and epidemiological data for each setting. We constructed intervention scenarios representing improvements in tuberculosis services internationally and within the USA, individually and in combination, plus a base-case scenario representing continuation of current services. We simulated health and economic outcomes until 2100, using a Bayesian approach to quantify uncertainty in these outcomes.
Under the base-case scenario, US tuberculosis incidence was projected to decline to 1·8 cases per 100 000 (95% uncertainty interval [UI] 1·5-2·1) in the total population by 2050. Intervention scenarios produced substantial reductions in tuberculosis incidence, with the combination of all domestic and international interventions projected to achieve pre-elimination by 2033 (95% UI 2031-2037). Compared with the base-case scenario, this combination of interventions could avert 101 000 tuberculosis cases (95% UI 84 000-120 000) and 13 300 tuberculosis deaths (95% UI 10 500-16 300) in the USA from 2025 to 2050. Tuberculosis elimination was not projected before 2100.
Strengthening tuberculosis services domestically, promoting the development of more effective technologies and interventions, and supporting tuberculosis programmes in countries with a high tuberculosis burden are key strategies for accelerating progress towards tuberculosis elimination in the USA.
US Centers for Disease Control and Prevention.
在结核病发病率较低的环境中，消除结核病是一个长期目标。我们研究了美国达到结核病消除前阶段（发病率<1.0 例/10 万人）和消除阶段（发病率<0.1 例/10 万人）的途径，2023 年美国的发病率估计为 2.9 例/10 万人。
我们使用数学建模框架，模拟了未来移民到美国的国家的结核病服务变化以及美国国内结核病服务变化如何影响美国的结核病发病率。为此，我们使用了一套链接的传播动力学模型，根据每个环境的人口统计学和流行病学数据进行了校准。我们构建了干预方案，代表了国际和美国国内结核病服务的改善，单独和组合使用，以及代表当前服务继续的基本情况方案。我们使用贝叶斯方法模拟了 2100 年之前的健康和经济结果，以量化这些结果的不确定性。
在基本情况下，预计到 2050 年，美国总人口的结核病发病率将降至 1.8 例/10 万人（95%置信区间[UI]1.5-2.1）。干预方案使结核病发病率大幅下降，所有国内和国际干预措施的组合预计将在 2033 年达到消除前阶段（95%UI2031-2037）。与基本情况方案相比，这种干预措施的组合可以避免 2025 年至 2050 年期间美国 101000 例结核病病例（95%UI84000-120000）和 13300 例结核病死亡（95%UI10500-16300）。预计在 2100 年之前不会消除结核病。
加强国内结核病服务，促进更有效技术和干预措施的发展，并支持结核病负担高的国家的结核病规划，是在美国加速实现结核病消除的关键战略。
美国疾病控制与预防中心。
