Achieving a "step change" in the tuberculosis epidemic through comprehensive community-wide intervention: a...

Area of Science:

• Epidemiology
• Public Health
• Infectious Disease Modeling

Background:

• Global tuberculosis (TB) control efforts are not meeting World Health Organization targets.
• A perception exists that substantial reductions in TB burden are unachievable.
• However, intensive and comprehensive interventions show potential for significant epidemiological impact.

Purpose of the Study:

• To quantify the potential epidemiological impact of an intensive, realistic, community-wide TB campaign.
• To assess the impact of a "step change" in TB burden using existing tools.
• To evaluate the contribution of individual intervention components.

Main Methods:

• A compartmental model simulating TB transmission in a mid-sized Indian city was developed.
• The model assessed a one-time community-wide screening campaign with treatment for active TB and preventive therapy for latent TB infection (LTBI).
• The intervention included subsequent health system strengthening, estimating averted TB cases and deaths over 10 years.

Main Results:

• A campaign screening 70% of the adult population could avert 7800 cases and 1710 deaths per million over 10 years.
• Preventive therapy for LTBI accounted for 33.5% of averted deaths.
• Health system strengthening contributed 52.9% of averted deaths.

Conclusions:

• A one-time, comprehensive community campaign using existing tools can achieve meaningful, long-lasting epidemiological impact on TB.
• Successful treatment of latent TB infection (LTBI) is crucial for this success.
• Health system strengthening is vital for transforming the TB response.