Strategies for halting the rise of multidrug resistant TB epidemics: assessing the effect of early case detection and isolation
Authored by Jane M Heffernan, Aquino L Espindola, Affan Shoukat, Seyed M Moghadas, Marek Laskowski, Marie Varughese
Date Published: 2017
DOI: 10.1093/inthealth/ihw059
Sponsors:
National Science and Engineering Research Council of Canada (NSERC)
Platforms:
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Model Documentation:
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Abstract
Background: The increasing rates of multidrug resistant TB (MDR-TB) have
posed the question of whether control programs under enhanced directly
observed treatment, short-course (DOTS-Plus) are sufficient or
implemented optimally. Despite enhanced efforts on early case detection
and improved treatment regimens, direct transmission of MDR-TB remains a
major hurdle for global TB control.
Methods: We developed an agent-based simulation model of TB dynamics to
evaluate the effect of transmission reduction measures on the incidence
of MDR-TB. We implemented a 15-day isolation period following the start
of treatment in active TB cases. The model was parameterized with the
latest estimates derived from the published literature.
Results: We found that if high rates (over 90\%) of TB case
identification are achieved within 4 weeks of developing active TB, then
a 15-day patient isolation strategy with 50\% effectiveness in
interrupting disease transmission leads to 10\% reduction in the
incidence of MDR-TB over 10 years. If transmission is fully prevented,
the rise of MDR-TB can be halted within 10 years, but the temporal
reduction of MDR-TB incidence remains below 20\% in this period.
Conclusions: The impact of transmission reduction measures on the TB
incidence depends critically on the rates and timelines of case
identification. The high costs and adverse effects associated with
MDR-TB treatment warrant increased efforts and investments on measures
that can interrupt direct transmission through early case detection.
Tags
Agent-based modelling
emergence
Diagnosis
transmission
Transmission dynamics
Mycobacterium-tuberculosis
South-africa
Exogenous reinfection
Case isolation
Exogenous re-infection
Multidrug
resistant tb
Relapse
Short-course chemotherapy
Pulmonary tuberculosis
Dots-plus
Mdr-tb