Can Australia eliminate TB? Modelling immigration strategies for reaching MDG targets in a low-transmission setting

Authored by Justin T Denholm, Emma S McBryde

Date Published: 2014

DOI: 10.1111/1753-6405.12161

Sponsors: No sponsors listed

Platforms: MATLAB

Model Documentation: Other Narrative Flow charts

Model Code URLs: http://onlinelibrary.wiley.com/store/10.1111/1753-6405.12161/asset/supinfo/azph12161-sup-0001-S1.pdf?v=1&s=7124191455a63c449b4f9518b40b9348adedadd6

Abstract

Background: The 2050 Millennium Development Goals (MDG) for tuberculosis (TB) aim for elimination of TB as a public health issue. We used a mathematical modelling approach to evaluate the feasibility of this target in a low-prevalence setting with immigration-related strategies directed at latent tuberculosis. Methods: We used a stochastic individual-based model to simulate tuberculosis disease among immigrants to Victoria, Australia; a representative low-transmission setting. A variety of screening and treatment approaches aimed at preventing reactivation of latent infection were applied to evaluate overall tuberculosis incidence reduction and rates of multidrug resistant disease. Results: Without additional intervention, tuberculosis incidence was predicted to reach 34.5 cases/million by 2050. Strategies involving the introduction of an available screening/treatment combination reduced TB incidence to between 16.9-23.8 cases/million, and required screening of 136-427 new arrivals for each case of TB prevented. Limiting screening to higher incidence regions of origin was less effective but more efficient. Conclusions: Public health strategies targeting latent tuberculosis infection in immigrants may substantially reduce tuberculosis incidence in a low prevalence region. However, immigration-focused strategies cannot achieve the 2050 MDG and alternative or complementary approaches are required.

Tags

Epidemiology Impact Countries Latent tuberculosis Tuberculosis vaccines Victoria Benefits