Evaluating the impact of tuberculosis control: number of deaths prevented by short-course chemotherapy in China

Dye, Christopher; Zhao, Fang; Scheele, Suzanne; Williams, Brian

doi:10.1093/intjepid/29.3.558

Cited by 22 publications

(20 citation statements)

References 6 publications

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“…However, the study fi ndings indicate that widely implementing the Directly Observed Therapy Short-Course (DOTS) strategy and prioritizing migrant population, districts with the lowest HDI as well as targeting those at higher risk of progressing to severe disease will favor a rapidly reduction of TB mortality as achieved by other countries where TB was also a serious public health concern. 6,7,19 Free and universal access to TB diagnosis and treatment, broad coverage of primary care services and low prevalence of multidrug-resistant Mycobacterium tuberculosis 4,21 will create favorable grounds for rapidly reducing TB mortality in Brazil.…”

Section: Discussionmentioning

confidence: 99%

Perfil de pacientes que evoluem para óbito por tuberculose no município de São Paulo, 2002

et al. 2008

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RESULTS:Of all tuberculosis deaths identifi ed, 78% had pulmonary form. Tuberculosis diagnosis was made after death in 30% and in primary health care units in 14%. Of them, 44% had not started treatment; 49% were not notifi ed; and 76% were men. The median age was 51 years; 52% had up to four years of schooling; 4% were probably living in the streets. Mortality rate increased with age; it was 5.0/100,000 for the entire city, ranging between zero to 35 according to the district. Previous treatment was reported for 82 out of 232 patients, and of them, 41 defaulted treatment. Diabetes (16%), chronic obstructive pulmonary disease (19%), HIV infection (11%), smoking (71%), and alcohol abuse (64%) were also reported. CONCLUSIONS:Adult males over 50, migrants and living in lower Human Development Index districts were more likely to die of tuberculosis. Low schooling and comorbidities are relevant characteristics. Low involvement of primary care units in tuberculosis diagnosis and high underreporting of cases were also seen.

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Section: Discussionmentioning

confidence: 99%

Perfil de pacientes que evoluem para óbito por tuberculose no município de São Paulo, 2002

et al. 2008

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“…“Treatment is Prevention” was a popular slogan for tuberculosis >20 years ago, and models were constructed to use this strategy to improve tuberculosis control in Africa and elsewhere [15-18]. Multiple studies have shown that treatment can reduce the incidence of sexually transmitted infections other than HIV-1 infection [19].…”

Section: Treatment As Preventionmentioning

confidence: 99%

Rethinking Prevention of HIV Type 1 Infection

2010

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Research on the prevention of human immunodeficiency virus (HIV)–1 infection is at a critical juncture. Major methodological challenges to performing prevention trials have emerged, and one after another promising biomedical interventions have failed to reduce the incidence of HIV-1 infection. Nevertheless, there is growing optimism that progress can be achieved in the near term. Mathematical modeling indicates that 2 new strategies, “test and treat” and preexposure prophylaxis, could have a major impact on the incidence of HIV-1 infection. Will our hopes be justified? We review the potential strengths and limitations of these antiretroviral “treatment as prevention” strategies and outline other new options for reducing the incidence of HIV-1 infection in the near term. By maximizing the potential of existing interventions, developing other effective strategies, and combining them in an optimal manner, we have the opportunity to bring the HIV-1 epidemic under control.

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“…The DOTS strategy has significantly improved treatment success rates for individual patients (4) and, where studies have been attempted, has been associated with reduced TB-related mortality in populations (5,6). Despite clear successes of DOTS programs, there are inherent shortcomings of PCF since this approach may result in either delayed or missed opportunities for diagnosis.…”

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confidence: 99%

Identifying dynamic tuberculosis case-finding policies for HIV/TB coepidemics

Yaesoubi

Cohen

2013

Proc. Natl. Acad. Sci. U.S.A.

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The global tuberculosis (TB) control plan has historically emphasized passive case finding (PCF) as the most practical approach for identifying TB suspects in high burden settings. The success of this approach in controlling TB depends on infectious individuals recognizing their symptoms and voluntarily seeking diagnosis rapidly enough to reduce onward transmission. It now appears, at least in some settings, that more intensified case-finding (ICF) approaches may be needed to control TB transmission; these more aggressive approaches for detecting as-yet undiagnosed cases obviously require additional resources to implement. Given that TB control programs are resource constrained and that the incremental yield of ICF is expected to wane over time as the pool of undiagnosed cases is depleted, a tool that can help policymakers to identify when to implement or suspend an ICF intervention would be valuable. In this article, we propose dynamic case-finding policies that allow policymakers to use existing observations about the epidemic and resource availability to determine when to switch between PCF and ICF to efficiently use resources to optimize population health. Using mathematical models of TB/HIV coepidemics, we show that dynamic policies strictly dominate static policies that prespecify a frequency and duration of rounds of ICF. We also find that the use of a diagnostic tool with better sensitivity for detecting smear-negative cases (e.g., Xpert MTB/RIF) further improves the incremental benefit of these dynamic case-finding policies. (1), emphasizes passive case finding (PCF) as a central tactic for identifying infectious cases requiring treatment. PCF approaches depend on individuals with symptomatic TB to seek out treatment on their own, a practice that is supported by studies indicating that the most infectious patients are aware of their symptoms and seek care (2, 3). Adoption of PCF strategies has been motivated by practical considerations as well. In most high TB incidence settings, resources are limited and PCF allows diagnostic efforts to be focused within existing health facilities and concentrated among suspects at highest risk of TB.The DOTS strategy has significantly improved treatment success rates for individual patients (4) and, where studies have been attempted, has been associated with reduced TB-related mortality in populations (5, 6). Despite clear successes of DOTS programs, there are inherent shortcomings of PCF since this approach may result in either delayed or missed opportunities for diagnosis. These limitations may be especially important in settings where HIV has emerged and triggered large and rapid increases in TB incidence (7).There are many different types of interventions that could be used to increase the vigorousness of TB case detection efforts beyond PCF; in this article, we broadly refer to these alternative approaches as intensified case finding (ICF). ICF approaches are often subclassified as either "enhanced" or "active" case finding and are differentiated by whether emph...

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Evaluating the impact of tuberculosis control: number of deaths prevented by short-course chemotherapy in China

Abstract: Short-course chemotherapy has substantially reduced TB mortality in half of China. The analytical method described here could be applied to TB control operations in many other countries, and should help to quantify the true burden of tuberculosis alleviated by SSCC.

Cited by 22 publications

References 6 publications

Perfil de pacientes que evoluem para óbito por tuberculose no município de São Paulo, 2002

Perfil de pacientes que evoluem para óbito por tuberculose no município de São Paulo, 2002

Rethinking Prevention of HIV Type 1 Infection

Identifying dynamic tuberculosis case-finding policies for HIV/TB coepidemics

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