2E-6 IMPACT OF TUBERCULOSIS CONTROL INTERVENTIONS TARGETED TO PREVIOUSLY TREATED PEOPLE IN A HIGH-BURDEN SETTING

Monday, October 24, 2016: 5:15 PM
Bayshore Ballroom Salon E, Lobby Level (Westin Bayshore Vancouver)

Reza Yaesoubi, PhD1, Florian Marx, MD, MSc1, Nicolas Menzies, PhD2, Joshua Salomon, PhD3, Nulda Beyers, MD, PhD4 and Ted Cohen, DPH, MD, MPH1, (1)Yale School of Public Health, New Haven, CT, (2)Center for Health Decision Science - Harvard T.H. Chan School of Public Health, Boston, MA, (3)Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, (4)Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Cape Town, South Africa

Purpose: Targeted delivery of specific interventions may be an effective approach for improving TB control in high-burden settings. In Southern Africa, individuals previously treated for TB who develop TB again (recurrent TB), contribute substantially to the TB burden and might thus be especially attractive for targeted interventions. The purpose of this study was to estimate the impact of interventions to actively detect and prevent recurrent TB among previously treated people on TB incidence and mortality in a high-burden setting.

Methods: We developed a transmission dynamic model of a TB/HIV co-epidemic among individuals with and without a history of TB treatment in a high-incidence community in suburban Cape Town, South Africa. The model was calibrated to local demography, TB and HIV prevalence, TB case notifications and TB control program data. The interventions modeled were (1) targeted active TB case finding (TACF) alone and (2) in combination with lifelong secondary isoniazid preventive therapy (2°IPT), both among individuals who previously completed TB treatment.

Results: Our model projects that a combination of annual TACF and 2°IPT among individuals who have previously completed TB treatment would lead to a 12.8% (95% Uncertainty Interval: 9.5%, 16.1%) reduction in incident cases of active TB and a 19.7% (16.2%, 23.2%) reduction in TB deaths compared to the projected status-quo over a 10 year period following the introduction of these interventions (Figures A-B). Implementing this targeted strategy would require screening 36 (25, 48) thousand individuals and provision of 2.25 (1.51, 3.04) million IPT doses over 10 years (Figures C-D). We project that during this 10-year time period, the targeted case finding and prevention strategy described above reduces the expected number of individuals who would require treatment for active TB (Figure E).

Conclusions: Our results suggest that in a high TB burden setting, active case finding and secondary preventive therapy targeted to individuals with previous complete TB treatment could accelerate declines in TB incidence and mortality. While promising, further work is needed to understand the cost and resource demands of these targeted strategies in order to determine the cost-effectiveness of these interventions.

See more of: ORAL ABSTRACTS: INFECTIOUS DISEASE CONTROL

See more of: 38th Annual North American Meeting of the Society for Medical Decision Making