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Published on: April 5, 2017
Optimising screening for recurrent tuberculosis: a microsimulation-based study
Emily A Kendall1, Samyra R Cox2, Abhay Kadam3
1Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA ekendall@jhmi.edu.
BMJ Global Health
|August 4, 2026
Summary
Active case-finding for recurrent tuberculosis (TB) in India can reduce symptomatic and infectious TB. Early screening and universal bacteriologic testing significantly improve outcomes, though symptom-based screening remains most affordable.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Health Economics
Background:
- Tuberculosis (TB) survivors face a high risk of recurrence, necessitating effective strategies for early detection.
- The optimal implementation and impact of active case-finding for TB recurrence remain uncertain, particularly in high-burden settings like India.
Purpose of the Study:
- To model the impact and cost-effectiveness of different active case-finding strategies for TB recurrence in India.
- To estimate the reduction in symptomatic and infectious TB over a 2-year period post-treatment.
Main Methods:
- Development of an individual-level stochastic simulation model of TB recurrence.
- Modeling post-treatment symptom screening at varying intervals with and without universal near-point-of-care bacteriological testing.
- Estimation of averted symptomatic and infectious TB time and associated screening program costs.
Main Results:
- Symptomatic TB recurred in 10% of recent TB survivors within 2 years.
- Early symptom screening (3, 6, 9 months) averted 26% of symptomatic and 16% of infectious TB time.
- Adding universal bacteriologic testing at 3 months doubled the impact on transmission potential, averting 37% of infectious time.
Conclusions:
- Screening for recurrent TB in India can significantly reduce morbidity and transmission.
- Concentrating screening efforts within the first year post-treatment yields the greatest impact.
- Symptom-based screening is cost-effective, while testing for asymptomatic cases further reduces transmission potential.
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