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Tuberculosis Control in South African Gold Mines: Mathematical Modeling of a Trial of Community-Wide Isoniazid Preventive Therapy
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 ma...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388015/ https://www.ncbi.nlm.nih.gov/pubmed/25792607 http://dx.doi.org/10.1093/aje/kwu320 |
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author | Vynnycky, Emilia Sumner, Tom Fielding, Katherine L. Lewis, James J. Cox, Andrew P. Hayes, Richard J. Corbett, Elizabeth L. Churchyard, Gavin J. Grant, Alison D. White, Richard G. |
author_facet | Vynnycky, Emilia Sumner, Tom Fielding, Katherine L. Lewis, James J. Cox, Andrew P. Hayes, Richard J. Corbett, Elizabeth L. Churchyard, Gavin J. Grant, Alison D. White, Richard G. |
author_sort | Vynnycky, Emilia |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-4388015 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-43880152015-12-16 Tuberculosis Control in South African Gold Mines: Mathematical Modeling of a Trial of Community-Wide Isoniazid Preventive Therapy Vynnycky, Emilia Sumner, Tom Fielding, Katherine L. Lewis, James J. Cox, Andrew P. Hayes, Richard J. Corbett, Elizabeth L. Churchyard, Gavin J. Grant, Alison D. White, Richard G. Am J Epidemiol Practice of Epidemiology 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. Oxford University Press 2015-04-15 2015-03-19 /pmc/articles/PMC4388015/ /pubmed/25792607 http://dx.doi.org/10.1093/aje/kwu320 Text en © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Practice of Epidemiology Vynnycky, Emilia Sumner, Tom Fielding, Katherine L. Lewis, James J. Cox, Andrew P. Hayes, Richard J. Corbett, Elizabeth L. Churchyard, Gavin J. Grant, Alison D. White, Richard G. Tuberculosis Control in South African Gold Mines: Mathematical Modeling of a Trial of Community-Wide Isoniazid Preventive Therapy |
title | Tuberculosis Control in South African Gold Mines: Mathematical Modeling of a Trial of Community-Wide Isoniazid Preventive Therapy |
title_full | Tuberculosis Control in South African Gold Mines: Mathematical Modeling of a Trial of Community-Wide Isoniazid Preventive Therapy |
title_fullStr | Tuberculosis Control in South African Gold Mines: Mathematical Modeling of a Trial of Community-Wide Isoniazid Preventive Therapy |
title_full_unstemmed | Tuberculosis Control in South African Gold Mines: Mathematical Modeling of a Trial of Community-Wide Isoniazid Preventive Therapy |
title_short | Tuberculosis Control in South African Gold Mines: Mathematical Modeling of a Trial of Community-Wide Isoniazid Preventive Therapy |
title_sort | tuberculosis control in south african gold mines: mathematical modeling of a trial of community-wide isoniazid preventive therapy |
topic | Practice of Epidemiology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388015/ https://www.ncbi.nlm.nih.gov/pubmed/25792607 http://dx.doi.org/10.1093/aje/kwu320 |
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