Achieving a step change in the tuberculosis epidemic through comprehensive community-wide intervention: A model-based analysis

Background: Global progress towards reducing tuberculosis (TB) incidence and mortality has consistently lagged behind World Health Organization targets leading to a perception that large reductions in TB burden cannot be achieved. However, several recent and historical trials suggest that intervention efforts that are comprehensive and focused can have substantial epidemiological impact. We aimed to quantify the potential epidemiological impact of an intensive but realistic, community-wide campaign utilizing existing tools, and designed to achieve a “step change” in TB burden.

Methods: We developed a compartmental model of tuberculosis transmission in a mid-sized city in India, the country with the greatest absolute burden of TB worldwide. We modeled the impact of a campaign comprising one-time community-wide screening with treatment for TB disease and preventive therapy for latent TB infection (LTBI). This one-time intervention was followed by strengthening of tuberculosis-related h...

背景：全球在降低结核病（TB）发病率和死亡率方面的进展始终落后于世界卫生组织目标，这导致人们认为大幅降低TB负担无法实现。然而，近期及历史上的多项试验表明，全面且有针对性的干预措施可产生显著的流行病学影响。本研究旨在量化一项密集但切实可行、覆盖全社区的运动的潜在流行病学影响——该运动利用现有工具，旨在实现TB负担的“阶跃式变化”。

方法：我们针对印度一座中等规模城市开发了结核病传播的房室模型（compartmental model），印度是全球TB绝对负担最重的国家。我们模拟了一项运动的影响，该运动包括一次性全社区筛查，对TB患者进行治疗，并对潜伏性结核感染（LTBI）进行预防性治疗。这项一次性干预之后，会加强与结核病相关的h...