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Potential population level impact on tuberculosis incidence of using an mRNA expression signature correlate-of-risk test to target tuberculosis preventive therapy
Achieving the WHO End-Tuberculosis (TB) targets requires approaches to prevent progression to TB among individuals with Mycobacterium tuberculosis (M.tb) infection. Effective preventive therapy (PT) exists, but current tests have low specificity for identifying who, among those infected, is at risk...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Nature Publishing Group UK
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6668474/ https://www.ncbi.nlm.nih.gov/pubmed/31366947 http://dx.doi.org/10.1038/s41598-019-47645-z |
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author | Sumner, Tom Scriba, Thomas J. Penn-Nicholson, Adam Hatherill, Mark White, Richard G. |
author_facet | Sumner, Tom Scriba, Thomas J. Penn-Nicholson, Adam Hatherill, Mark White, Richard G. |
author_sort | Sumner, Tom |
collection | PubMed |
description | Achieving the WHO End-Tuberculosis (TB) targets requires approaches to prevent progression to TB among individuals with Mycobacterium tuberculosis (M.tb) infection. Effective preventive therapy (PT) exists, but current tests have low specificity for identifying who, among those infected, is at risk of developing TB. Using mathematical models, we assessed the potential population-level impact on TB incidence of using a new more specific mRNA expression signature (COR) to target PT among HIV-uninfected adults in South Africa. We compared the results to the use of the existing interferon-γ release assay (IGRA). With annual screening coverage of 30% COR-targeted PT could reduce TB incidence in 2035 by 20% (95% CI 15–27). With the same coverage, IGRA-targeted PT could reduce TB incidence by 39% (31–48) but would require greater use of PT resulting in a higher number needed to treat per TB case averted (COR: 49 (29–77); IGRA: 84 (59–123)). The relative differences between COR and IGRA were not sensitive to screening coverage. COR-targeted PT could contribute to reducing total TB burden in high incidence countries like South Africa by allowing more efficient targeting of treatment. To maximise impact, COR-like tests may be best utilised in the highest burden regions, or sub-populations, within these countries. |
format | Online Article Text |
id | pubmed-6668474 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Nature Publishing Group UK |
record_format | MEDLINE/PubMed |
spelling | pubmed-66684742019-08-06 Potential population level impact on tuberculosis incidence of using an mRNA expression signature correlate-of-risk test to target tuberculosis preventive therapy Sumner, Tom Scriba, Thomas J. Penn-Nicholson, Adam Hatherill, Mark White, Richard G. Sci Rep Article Achieving the WHO End-Tuberculosis (TB) targets requires approaches to prevent progression to TB among individuals with Mycobacterium tuberculosis (M.tb) infection. Effective preventive therapy (PT) exists, but current tests have low specificity for identifying who, among those infected, is at risk of developing TB. Using mathematical models, we assessed the potential population-level impact on TB incidence of using a new more specific mRNA expression signature (COR) to target PT among HIV-uninfected adults in South Africa. We compared the results to the use of the existing interferon-γ release assay (IGRA). With annual screening coverage of 30% COR-targeted PT could reduce TB incidence in 2035 by 20% (95% CI 15–27). With the same coverage, IGRA-targeted PT could reduce TB incidence by 39% (31–48) but would require greater use of PT resulting in a higher number needed to treat per TB case averted (COR: 49 (29–77); IGRA: 84 (59–123)). The relative differences between COR and IGRA were not sensitive to screening coverage. COR-targeted PT could contribute to reducing total TB burden in high incidence countries like South Africa by allowing more efficient targeting of treatment. To maximise impact, COR-like tests may be best utilised in the highest burden regions, or sub-populations, within these countries. Nature Publishing Group UK 2019-07-31 /pmc/articles/PMC6668474/ /pubmed/31366947 http://dx.doi.org/10.1038/s41598-019-47645-z Text en © The Author(s) 2019 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Article Sumner, Tom Scriba, Thomas J. Penn-Nicholson, Adam Hatherill, Mark White, Richard G. Potential population level impact on tuberculosis incidence of using an mRNA expression signature correlate-of-risk test to target tuberculosis preventive therapy |
title | Potential population level impact on tuberculosis incidence of using an mRNA expression signature correlate-of-risk test to target tuberculosis preventive therapy |
title_full | Potential population level impact on tuberculosis incidence of using an mRNA expression signature correlate-of-risk test to target tuberculosis preventive therapy |
title_fullStr | Potential population level impact on tuberculosis incidence of using an mRNA expression signature correlate-of-risk test to target tuberculosis preventive therapy |
title_full_unstemmed | Potential population level impact on tuberculosis incidence of using an mRNA expression signature correlate-of-risk test to target tuberculosis preventive therapy |
title_short | Potential population level impact on tuberculosis incidence of using an mRNA expression signature correlate-of-risk test to target tuberculosis preventive therapy |
title_sort | potential population level impact on tuberculosis incidence of using an mrna expression signature correlate-of-risk test to target tuberculosis preventive therapy |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6668474/ https://www.ncbi.nlm.nih.gov/pubmed/31366947 http://dx.doi.org/10.1038/s41598-019-47645-z |
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