The potential impact of preventive therapy against tuberculosis in the WHO South-East Asian Region: a modelling approach
Abstract Background The prevention of tuberculosis (TB) is key for accelerating current, slow declines in TB burden. The 2018 World Health Organization (WHO) guidelines on eligibility for preventive therapy to treat latent TB infection (LTBI) include people living with human immunodeficiency virus (...
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| Format: | Article |
| Language: | English |
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BMC
2020-07-01
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| Series: | BMC Medicine |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12916-020-01651-5 |
| _version_ | 1819200422829621248 |
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| author | Sandip Mandal Vineet Bhatia Mukta Sharma Partha Pratim Mandal Nimalan Arinaminpathy |
| author_facet | Sandip Mandal Vineet Bhatia Mukta Sharma Partha Pratim Mandal Nimalan Arinaminpathy |
| author_sort | Sandip Mandal |
| collection | DOAJ |
| description | Abstract Background The prevention of tuberculosis (TB) is key for accelerating current, slow declines in TB burden. The 2018 World Health Organization (WHO) guidelines on eligibility for preventive therapy to treat latent TB infection (LTBI) include people living with human immunodeficiency virus (PLHIV), household contacts of TB patients including children, and those with clinical conditions including silicosis, dialysis, transplantation, etc. and other country-specific groups. We aimed to estimate the potential impact of full implementation of these guidelines in the WHO South-East Asian (SEA) Region, which bears the largest burden of TB and LTBI amongst the WHO regions. Methods We developed mathematical models of TB transmission dynamics, calibrated individually to each of the 11 countries in the region. We modelled preventive therapy in the absence of other TB interventions. As an alternative comparator, reflecting ongoing developments in TB control in the region, we also simulated improvements in the treatment cascade for active TB, including private sector engagement and intensified case-finding. Relative to both scenarios, for each country in the region, we projected TB cases and deaths averted between 2020 and 2030, by full uptake of preventive therapy, defined as comprehensive coverage amongst eligible populations as per WHO guidelines, and assuming outcomes consistent with clinical trials. We also performed sensitivity analysis to illustrate impact under less-than-optimal conditions. Results At the regional level, full uptake of preventive therapy amongst identified risk groups would reduce annual incidence rates in 2030 by 8.30% (95% CrI 6.48–10.83) relative to 2015, in the absence of any additional interventions. If implemented against a backdrop of improved TB treatment cascades, preventive therapy would achieve an incremental 6.93 percentage points (95% CrI 5.81–8.51) of reduction in annual incidence rates, compared to 2015. At the regional level, the numbers of individuals with latent TB infection that need to be treated to avert 1 TB case is 64 (95% CrI 55–74). Sensitivity analysis illustrates that results for impact are roughly proportional to ‘effective coverage’ (the product of actual coverage and effectiveness of the regimen). Conclusions Full implementation of WHO guidelines is important for ending TB in the SEA Region. Although future strategies will need to be expanded to the population level, to achieve large declines in TB incidence, the uptake of current tools can offer a valuable step in this direction. |
| first_indexed | 2024-12-23T03:31:59Z |
| format | Article |
| id | doaj.art-d652b3a9aa6d49abb9444aee39959c00 |
| institution | Directory Open Access Journal |
| issn | 1741-7015 |
| language | English |
| last_indexed | 2024-12-23T03:31:59Z |
| publishDate | 2020-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medicine |
| spelling | doaj.art-d652b3a9aa6d49abb9444aee39959c002022-12-21T18:01:40ZengBMCBMC Medicine1741-70152020-07-0118111010.1186/s12916-020-01651-5The potential impact of preventive therapy against tuberculosis in the WHO South-East Asian Region: a modelling approachSandip Mandal0Vineet Bhatia1Mukta Sharma2Partha Pratim Mandal3Nimalan Arinaminpathy4Indian Council of Medical ResearchSouth-East Asian Regional Office, World Health OrganizationSouth-East Asian Regional Office, World Health OrganizationSouth-East Asian Regional Office, World Health OrganizationMRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College LondonAbstract Background The prevention of tuberculosis (TB) is key for accelerating current, slow declines in TB burden. The 2018 World Health Organization (WHO) guidelines on eligibility for preventive therapy to treat latent TB infection (LTBI) include people living with human immunodeficiency virus (PLHIV), household contacts of TB patients including children, and those with clinical conditions including silicosis, dialysis, transplantation, etc. and other country-specific groups. We aimed to estimate the potential impact of full implementation of these guidelines in the WHO South-East Asian (SEA) Region, which bears the largest burden of TB and LTBI amongst the WHO regions. Methods We developed mathematical models of TB transmission dynamics, calibrated individually to each of the 11 countries in the region. We modelled preventive therapy in the absence of other TB interventions. As an alternative comparator, reflecting ongoing developments in TB control in the region, we also simulated improvements in the treatment cascade for active TB, including private sector engagement and intensified case-finding. Relative to both scenarios, for each country in the region, we projected TB cases and deaths averted between 2020 and 2030, by full uptake of preventive therapy, defined as comprehensive coverage amongst eligible populations as per WHO guidelines, and assuming outcomes consistent with clinical trials. We also performed sensitivity analysis to illustrate impact under less-than-optimal conditions. Results At the regional level, full uptake of preventive therapy amongst identified risk groups would reduce annual incidence rates in 2030 by 8.30% (95% CrI 6.48–10.83) relative to 2015, in the absence of any additional interventions. If implemented against a backdrop of improved TB treatment cascades, preventive therapy would achieve an incremental 6.93 percentage points (95% CrI 5.81–8.51) of reduction in annual incidence rates, compared to 2015. At the regional level, the numbers of individuals with latent TB infection that need to be treated to avert 1 TB case is 64 (95% CrI 55–74). Sensitivity analysis illustrates that results for impact are roughly proportional to ‘effective coverage’ (the product of actual coverage and effectiveness of the regimen). Conclusions Full implementation of WHO guidelines is important for ending TB in the SEA Region. Although future strategies will need to be expanded to the population level, to achieve large declines in TB incidence, the uptake of current tools can offer a valuable step in this direction.http://link.springer.com/article/10.1186/s12916-020-01651-5Preventive therapyEpidemiologyModellingSouth East AsiaTuberculosis |
| spellingShingle | Sandip Mandal Vineet Bhatia Mukta Sharma Partha Pratim Mandal Nimalan Arinaminpathy The potential impact of preventive therapy against tuberculosis in the WHO South-East Asian Region: a modelling approach BMC Medicine Preventive therapy Epidemiology Modelling South East Asia Tuberculosis |
| title | The potential impact of preventive therapy against tuberculosis in the WHO South-East Asian Region: a modelling approach |
| title_full | The potential impact of preventive therapy against tuberculosis in the WHO South-East Asian Region: a modelling approach |
| title_fullStr | The potential impact of preventive therapy against tuberculosis in the WHO South-East Asian Region: a modelling approach |
| title_full_unstemmed | The potential impact of preventive therapy against tuberculosis in the WHO South-East Asian Region: a modelling approach |
| title_short | The potential impact of preventive therapy against tuberculosis in the WHO South-East Asian Region: a modelling approach |
| title_sort | potential impact of preventive therapy against tuberculosis in the who south east asian region a modelling approach |
| topic | Preventive therapy Epidemiology Modelling South East Asia Tuberculosis |
| url | http://link.springer.com/article/10.1186/s12916-020-01651-5 |
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