Year : 2019 | Volume
: 149 | Issue : 4 | Page : 517--527
Strategies for ending tuberculosis in the South-East Asian Region: A modelling approach
Nimalan Arinaminpathy1, Sandip Mandal2, Vineet Bhatia3, Ross McLeod4, Mukta Sharma3, Soumya Swaminathan5, Khurshid Alam Hyder3, Partha Pratim Mandal3, Swarup Kumar Sarkar3, Poonam Khetrapal Singh3
1 Department of Infectious Disease Epidemiology, St. Mary's Hospital, Imperial College, London, UK
2 Public Health Foundation of India, New Delhi, India
3 World Health Organization, South-East Asian Regional Office, New Delhi, India
4 eSYS Development, Sydney, Australia
5 Indian Council of Medical Research, New Delhi, India
Background & objectives: To support recent political commitments to end tuberculosis (TB) in the World Health Organization South-East Asian Region (SEAR), there is a need to understand by what measures, and with what investment, these goals could be reached. These questions were addressed by using mathematical models of TB transmission by doing the analysis on a country-by-country basis in SEAR.
Methods: A dynamical model of TB transmission was developed, in consultation with each of the 11 countries in the SEAR. Three intervention scenarios were examined: (i) strengthening basic TB services (including private sector engagement), (ii) accelerating TB case-finding and notification, and (iii) deployment of a prognostic biomarker test by 2025, to guide mass preventive therapy of latent TB infection. Each scenario was built on the preceding ones, in successive combination.
Results: Comprehensive improvements in basic TB services by 2020, in combination with accelerated case-finding to increase TB detection by at least two-fold by 2020, could lead to a reduction in TB incidence rates in SEAR by 67.3 per cent [95% credible intervals (CrI) 65.3-69.8] and TB deaths by 80.9 per cent (95% CrI 77.9-84.7) in 2035, relative to 2015. These interventions alone would require an additional investment of at least US$ 25 billion. However, their combined effect is insufficient to reach the end TB targets of 80 per cent by 2030 and 90 per cent by 2035. Model projections show how additionally, deployment of a biomarker test by 2025 could end TB in the region by 2035. Targeting specific risk groups, such as slum dwellers, could mitigate the coverage needed in the general population, to end TB in the Region.
Interpretation & conclusions: While the scale-up of currently available strategies may play an important role in averting TB cases and deaths in the Region, there will ultimately be a need for novel, mass preventive measures, to meet the end TB goals. Achieving these impacts will require a substantial escalation in funding for TB control in the Region.
Dr Nimalan Arinaminpathy
Department of Infectious Disease Epidemiology, St. Mary's Hospital, Imperial College London, London
|How to cite this article:|
Arinaminpathy N, Mandal S, Bhatia V, McLeod R, Sharma M, Swaminathan S, Hyder KA, Mandal PP, Sarkar SK, Singh PK. Strategies for ending tuberculosis in the South-East Asian Region: A modelling approach.Indian J Med Res 2019;149:517-527
|How to cite this URL:|
Arinaminpathy N, Mandal S, Bhatia V, McLeod R, Sharma M, Swaminathan S, Hyder KA, Mandal PP, Sarkar SK, Singh PK. Strategies for ending tuberculosis in the South-East Asian Region: A modelling approach. Indian J Med Res [serial online] 2019 [cited 2020 Aug 5 ];149:517-527
Available from: http://www.ijmr.org.in/article.asp?issn=0971-5916;year=2019;volume=149;issue=4;spage=517;epage=527;aulast=Arinaminpathy;type=0