Background Undernutrition is the leading cause of tuberculosis (TB) in India and is associated with increased TB mortality. Undernutrition also decreases quality of life and economic productivity. Material and Methods We assessed the cost-effectiveness of providing augmented rations to undernourished Indians through the government’s Targeted Public Distribution System (TPDS). We used Markov state transition models to simulate disease progression and mortality among undernourished individuals in three groups: general population, household contacts (HHCs) of people living with TB, and persons with HIV. The models calculate costs and outcomes (TB cases, TB deaths, and disability-adjusted life years, DALYs) associated with a 2600 KCal/day diet for adults with body mass index [BMI] of 16-18.4 kg/m 2 until they attain a BMI of 20kg/m 2 compared to a status quo scenario wherein TPDS rations are unchanged. We employed deterministic and probabilistic sensitivity analyses to test result robustness. Results Over 5 years, augmented rations could avert 81% of TB cases and 88% of TB deaths among currently undernourished Indians. Correspondingly, this intervention could forestall 78% and 48% of TB cases and prevent 88% and 70% of deaths among undernourished HHCs and HIV-infected persons, respectively. Augmented rations resulted in ten-fold higher resolution of undernutrition and were highly cost-effective with (incremental cost effectiveness ratio (ICER) of $470/DALY averted). ICER was lower for HHCs ($360/DALY averted) and the HIV population ($250/DALY averted). Conclusions A robust nutritional intervention would be highly cost-effective in reducing TB incidence and mortality while reducing chronic undernutrition in India.

No abstract

Background In people with hepatitis B virus (HBV) infection, persistence of HBV “e” antigen (HBeAg) is associated with clinical progression and need for treatment. HBeAg loss represents partial immune control and is a critical event in the natural history of chronic HBV. Methods We conducted a systematic review and meta-analysis of cohort studies that report HBeAg loss among people with untreated chronic HBV. We evaluated HBeAg loss using a random-effects model and conducted subanalysis on region. Results We screened 10,560 publications, performed 196 full text analyses, and included 26 studies for meta-analysis. The pooled rate of HBeAg loss was 6.46/100 person-years (PYs) (95% CI: 5.17, 8.08). Meta-regression showed that older age of participants and studies in Europe were associated with higher rate of HBeAg loss. Rates were: 7.43/100 PYs (95%CI: 6.30, 8.75; 1 study) in Africa; 3.24/100 PYs (95%CI: 2.61, 4.02; 1 study) in the Eastern Mediterranean; 13.67/100 PYs (95%CI:11.21, 16.66; 4 studies) in Europe; 7.34/100 PYs (95%CI:4.61, 11.70; 5 studies) in North America; 5.53/100 PYs (95%CI:4.05, 7.55; 15 studies) in the Western Pacific. Conclusions Spontaneous HBeAg loss occurs at a rate of 6.46/100 PYs. Variations by region and age group may reflect epidemiological, immunological, or HBV genotype-related differences.