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Strategic investment in tuberculosis control in the Republic of Bulgaria
As Bulgaria transitions away from Global Fund grant, robust estimates of the comparative impact of the various response strategies under consideration are needed to ensure sustained effectiveness of the tuberculosis (TB) programme. We tailored an established mathematical model for TB control to the...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Cambridge University Press
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6873158/ https://www.ncbi.nlm.nih.gov/pubmed/31736454 http://dx.doi.org/10.1017/S0950268819001857 |
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author | Doan, T. N. Varleva, T. Zamfirova, M. Tyufekchieva, M. Keshelava, A. Hristov, K. Yaneva, A. Gadzheva, B. Zhang, S. Irbe, S. Ragonnet, R. McBryde, E. S. Trauer, J. M. |
author_facet | Doan, T. N. Varleva, T. Zamfirova, M. Tyufekchieva, M. Keshelava, A. Hristov, K. Yaneva, A. Gadzheva, B. Zhang, S. Irbe, S. Ragonnet, R. McBryde, E. S. Trauer, J. M. |
author_sort | Doan, T. N. |
collection | PubMed |
description | As Bulgaria transitions away from Global Fund grant, robust estimates of the comparative impact of the various response strategies under consideration are needed to ensure sustained effectiveness of the tuberculosis (TB) programme. We tailored an established mathematical model for TB control to the epidemic in Bulgaria to project the likely outcomes of seven intervention scenarios. Under existing programmatic conditions projected forward, the country's targets for achieving TB elimination in the coming decades will not be achieved. No interventions under consideration were predicted to accelerate the baseline projected reduction in epidemiological indicators significantly. Discontinuation of the ‘Open Doors’ program and activities of non-governmental organisations would result in a marked exacerbation of the epidemic (increasing incidence in 2035 by 6–8% relative to baseline conditions projected forward). Changing to a short course regimen for multidrug-resistant TB (MDR-TB) would substantially decrease MDR-TB mortality (by 21.6% in 2035 relative to baseline conditions projected forward). Changing to ambulatory care for eligible patients would not affect TB burden but would be markedly cost-saving. In conclusion, Bulgaria faces important challenges in transitioning to a primarily domestically-financed TB programme. The country should consider maintaining currently effective programs and shifting towards ambulatory care to ensure program sustainability. |
format | Online Article Text |
id | pubmed-6873158 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Cambridge University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-68731582019-12-04 Strategic investment in tuberculosis control in the Republic of Bulgaria Doan, T. N. Varleva, T. Zamfirova, M. Tyufekchieva, M. Keshelava, A. Hristov, K. Yaneva, A. Gadzheva, B. Zhang, S. Irbe, S. Ragonnet, R. McBryde, E. S. Trauer, J. M. Epidemiol Infect Original Paper As Bulgaria transitions away from Global Fund grant, robust estimates of the comparative impact of the various response strategies under consideration are needed to ensure sustained effectiveness of the tuberculosis (TB) programme. We tailored an established mathematical model for TB control to the epidemic in Bulgaria to project the likely outcomes of seven intervention scenarios. Under existing programmatic conditions projected forward, the country's targets for achieving TB elimination in the coming decades will not be achieved. No interventions under consideration were predicted to accelerate the baseline projected reduction in epidemiological indicators significantly. Discontinuation of the ‘Open Doors’ program and activities of non-governmental organisations would result in a marked exacerbation of the epidemic (increasing incidence in 2035 by 6–8% relative to baseline conditions projected forward). Changing to a short course regimen for multidrug-resistant TB (MDR-TB) would substantially decrease MDR-TB mortality (by 21.6% in 2035 relative to baseline conditions projected forward). Changing to ambulatory care for eligible patients would not affect TB burden but would be markedly cost-saving. In conclusion, Bulgaria faces important challenges in transitioning to a primarily domestically-financed TB programme. The country should consider maintaining currently effective programs and shifting towards ambulatory care to ensure program sustainability. Cambridge University Press 2019-11-18 /pmc/articles/PMC6873158/ /pubmed/31736454 http://dx.doi.org/10.1017/S0950268819001857 Text en © The Author(s) 2019 http://creativecommons.org/licenses/by/4.0/ This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Paper Doan, T. N. Varleva, T. Zamfirova, M. Tyufekchieva, M. Keshelava, A. Hristov, K. Yaneva, A. Gadzheva, B. Zhang, S. Irbe, S. Ragonnet, R. McBryde, E. S. Trauer, J. M. Strategic investment in tuberculosis control in the Republic of Bulgaria |
title | Strategic investment in tuberculosis control in the Republic of Bulgaria |
title_full | Strategic investment in tuberculosis control in the Republic of Bulgaria |
title_fullStr | Strategic investment in tuberculosis control in the Republic of Bulgaria |
title_full_unstemmed | Strategic investment in tuberculosis control in the Republic of Bulgaria |
title_short | Strategic investment in tuberculosis control in the Republic of Bulgaria |
title_sort | strategic investment in tuberculosis control in the republic of bulgaria |
topic | Original Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6873158/ https://www.ncbi.nlm.nih.gov/pubmed/31736454 http://dx.doi.org/10.1017/S0950268819001857 |
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