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2015 ; 181
(8
): 619-32
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Tuberculosis control in South African gold mines: mathematical modeling of a
trial of community-wide isoniazid preventive therapy
#MMPMID25792607
Vynnycky E
; Sumner T
; Fielding KL
; Lewis JJ
; Cox AP
; Hayes RJ
; Corbett EL
; Churchyard GJ
; Grant AD
; White RG
Am J Epidemiol
2015[Apr]; 181
(8
): 619-32
PMID25792607
show ga
A recent major cluster randomized trial of screening, active disease treatment,
and mass isoniazid preventive therapy for 9 months during 2006-2011 among South
African gold miners showed reduced individual-level tuberculosis incidence but no
detectable population-level impact. We fitted a dynamic mathematical model to
trial data and explored 1) factors contributing to the lack of population-level
impact, 2) the best-achievable impact if all implementation characteristics were
increased to the highest level achieved during the trial ("optimized
intervention"), and 3) how tuberculosis might be better controlled with
additional interventions (improving diagnostics, reducing treatment delay,
providing isoniazid preventive therapy continuously to human immunodeficiency
virus-positive people, or scaling up antiretroviral treatment coverage)
individually and in combination. We found the following: 1) The model suggests
that a small proportion of latent infections among human immunodeficiency
virus-positive people were cured, which could have been a key factor explaining
the lack of detectable population-level impact. 2) The optimized implementation
increased impact by only 10%. 3) Implementing additional interventions
individually and in combination led to up to 30% and 75% reductions,
respectively, in tuberculosis incidence after 10 years. Tuberculosis control
requires a combination prevention approach, including health systems
strengthening to minimize treatment delay, improving diagnostics, increased
antiretroviral treatment coverage, and effective preventive treatment regimens.
|*Models, Theoretical
[MESH]
|Adult
[MESH]
|Antitubercular Agents/*therapeutic use
[MESH]
|Gold
[MESH]
|HIV Infections/complications
[MESH]
|Humans
[MESH]
|Isoniazid/*therapeutic use
[MESH]
|Middle Aged
[MESH]
|Mining
[MESH]
|Public Health Practice/*statistics & numerical data
[MESH]