Population-level impact of active tuberculosis case finding in an Asian megacity.

<h4>Background</h4>The potential population-level impact of private-sector initiatives for tuberculosis (TB) case finding in Southeast Asia remains uncertain. In 2011, the Indus Hospital TB Control Program in Karachi, Pakistan, undertook an aggressive case-finding campaign that doubled n...

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Main Authors: David W Dowdy, Ismat Lotia, Andrew S Azman, Jacob Creswell, Suvanand Sahu, Aamir J Khan
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2013-01-01
Series:PLoS ONE
Online Access:https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24147015/pdf/?tool=EBI
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spelling doaj-2ad62aa169254603adac40fc17b5ce5d2021-03-03T22:49:37ZengPublic Library of Science (PLoS)PLoS ONE1932-62032013-01-01810e7751710.1371/journal.pone.0077517Population-level impact of active tuberculosis case finding in an Asian megacity.David W DowdyIsmat LotiaAndrew S AzmanJacob CreswellSuvanand SahuAamir J Khan<h4>Background</h4>The potential population-level impact of private-sector initiatives for tuberculosis (TB) case finding in Southeast Asia remains uncertain. In 2011, the Indus Hospital TB Control Program in Karachi, Pakistan, undertook an aggressive case-finding campaign that doubled notification rates, providing an opportunity to investigate potential population-level effects.<h4>Methods</h4>We constructed an age-structured compartmental model of TB in the intervention area. We fit the model using field and literature data, assuming that TB incidence equaled the estimated nationwide incidence in Pakistan (primary analysis), or 1.5 times greater (high-incidence scenario). We modeled the intervention as an increase in the rate of formal-sector TB diagnosis and evaluated the potential impact of sustaining this rate for five years.<h4>Results</h4>In the primary analysis, the five-year intervention averted 24% (95% uncertainty range, UR: 18-30%) of five-year cumulative TB cases and 52% (95% UR: 45-57%) of cumulative TB deaths. Corresponding reductions in the high-incidence scenario were 12% (95% UR: 8-17%) and 27% (95% UR: 21-34%), although the absolute number of lives saved was higher. At the end of five years, TB notification rates in the primary analysis were below their 2010 baseline, incidence had dropped by 45%, and annual mortality had fallen by 72%. About half of the cumulative impact on incidence and mortality could be achieved with a one-year intervention.<h4>Conclusions</h4>Sustained, multifaceted, and innovative approaches to TB case-finding in Asian megacities can have substantial community-wide epidemiological impact.https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24147015/pdf/?tool=EBI
collection DOAJ
language English
format Article
sources DOAJ
author David W Dowdy
Ismat Lotia
Andrew S Azman
Jacob Creswell
Suvanand Sahu
Aamir J Khan
spellingShingle David W Dowdy
Ismat Lotia
Andrew S Azman
Jacob Creswell
Suvanand Sahu
Aamir J Khan
Population-level impact of active tuberculosis case finding in an Asian megacity.
PLoS ONE
author_facet David W Dowdy
Ismat Lotia
Andrew S Azman
Jacob Creswell
Suvanand Sahu
Aamir J Khan
author_sort David W Dowdy
title Population-level impact of active tuberculosis case finding in an Asian megacity.
title_short Population-level impact of active tuberculosis case finding in an Asian megacity.
title_full Population-level impact of active tuberculosis case finding in an Asian megacity.
title_fullStr Population-level impact of active tuberculosis case finding in an Asian megacity.
title_full_unstemmed Population-level impact of active tuberculosis case finding in an Asian megacity.
title_sort population-level impact of active tuberculosis case finding in an asian megacity.
publisher Public Library of Science (PLoS)
series PLoS ONE
issn 1932-6203
publishDate 2013-01-01
description <h4>Background</h4>The potential population-level impact of private-sector initiatives for tuberculosis (TB) case finding in Southeast Asia remains uncertain. In 2011, the Indus Hospital TB Control Program in Karachi, Pakistan, undertook an aggressive case-finding campaign that doubled notification rates, providing an opportunity to investigate potential population-level effects.<h4>Methods</h4>We constructed an age-structured compartmental model of TB in the intervention area. We fit the model using field and literature data, assuming that TB incidence equaled the estimated nationwide incidence in Pakistan (primary analysis), or 1.5 times greater (high-incidence scenario). We modeled the intervention as an increase in the rate of formal-sector TB diagnosis and evaluated the potential impact of sustaining this rate for five years.<h4>Results</h4>In the primary analysis, the five-year intervention averted 24% (95% uncertainty range, UR: 18-30%) of five-year cumulative TB cases and 52% (95% UR: 45-57%) of cumulative TB deaths. Corresponding reductions in the high-incidence scenario were 12% (95% UR: 8-17%) and 27% (95% UR: 21-34%), although the absolute number of lives saved was higher. At the end of five years, TB notification rates in the primary analysis were below their 2010 baseline, incidence had dropped by 45%, and annual mortality had fallen by 72%. About half of the cumulative impact on incidence and mortality could be achieved with a one-year intervention.<h4>Conclusions</h4>Sustained, multifaceted, and innovative approaches to TB case-finding in Asian megacities can have substantial community-wide epidemiological impact.
url https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24147015/pdf/?tool=EBI
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