Mass treatment to eliminate tuberculosis from an island population
OBJECTIVE: To construct a mathematical model to predict whether mass treatment with a full course of anti-tuberculosis drugs might eliminate TB from the defined population of the Republic of Kiribati.
METHODS: We constructed a seven-state compartmental model of the life cycle of Mycobacterium tuberculosis in which active TB disease arises from the progression of infection, reinfection, reactivation and relapse, while distinguishing infectious from non-infectious disease. We evaluated the effects of 5-yearly mass treatment using a range of parameter values to generate outcomes in uncertainty analysis.
RESULTS: Assuming population-wide treatment effectiveness for latent tuberculous infection and active TB of 90%, annual TB incidence is expected to fall sharply at each 5-yearly round of treatment, approaching elimination in two decades. The model showed that the incidence rate is sensitive to the relapse rate after successful treatment of TB.
CONCLUSION: Mass treatment may help to eliminate TB, at least for discrete or geographically isolated populations.
Keywords: elimination; mass treatment; tuberculosis
Document Type: Research Article
Affiliations: 1: Centre for International Health, Department of Preventive and Social Medicine, Faculty of Medicine, University of Otago, Dunedin, New Zealand; 2: HIV/AIDS, Tuberculosis, Malaria & Neglected Tropical Diseases Cluster, World Health Organization, Geneva, Switzerland; 3: Public Health Division, Secretariat of the Pacific Community, Noumea Cedex, New Caledonia; 4: National Tuberculosis Control Programme, Ministry of Health and Medical Services, Republic of Kiribati; 5: International Union Against Tuberculosis and Lung Disease, Paris, France; 6: *South African Centre for Epidemiological Modelling and Analysis, Cape Town, South Africa; 7: Médecins Sans Frontières, Brussels Operational Centre, Luxembourg, Belgium; 8: Sydney Emerging Infectious Disease and Biosecurity Institute and Centre for Research Excellence in Tuberculosis, University of Sydney, Sydney, New South Wales, Australia;
Publication date: 01 August 2014
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