Dowdy D.W., Davis J.L., den Boon S., Walter N.D., Katamba A., Cattamanchi A.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States; Curry International Tuberculosis Center, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States; Makerere University-University of California San Francisco Research Collaboration, Kampala, Uganda; Division of Pulmonary and Critical Care Medicine, University of Colorado Denver, Aurora, CO, United States; Department of Medicine, Makerere University, Kampala, Uganda
Dowdy, D.W., Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Davis, J.L., Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States, Curry International Tuberculosis Center, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States; den Boon, S., Makerere University-University of California San Francisco Research Collaboration, Kampala, Uganda; Walter, N.D., Division of Pulmonary and Critical Care Medicine, University of Colorado Denver, Aurora, CO, United States; Katamba, A., Department of Medicine, Makerere University, Kampala, Uganda; Cattamanchi, A., Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States, Curry International Tuberculosis Center, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States
Objective:To compare the population-level impact of two World Health Organization-endorsed strategies for improving the diagnosis of tuberculosis (TB): same-day microscopy and Xpert MTB/RIF (Cepheid, USA).Methods:We created a compartmental transmission model of TB in a representative African community, fit to the regional incidence and mortality of TB and HIV. We compared the population-level reduction in TB burden over ten years achievable with implementation over two years of same-day microscopy, Xpert MTB/RIF testing, and the combination of both approaches.Findings:Same-day microscopy averted an estimated 11.0% of TB incidence over ten years (95% uncertainty range, UR: 3.3%-22.5%), and prevented 11.8% of all TB deaths (95% UR: 7.7%-27.1%). Scaling up Xpert MTB/RIF to all centralized laboratories to achieve 75% population coverage had similar impact on incidence (9.3% reduction, 95% UR: 1.9%-21.5%) and greater effect on mortality (23.8% reduction, 95% UR: 8.6%-33.4%). Combining the two strategies (i.e., same-day microscopy plus Xpert MTB/RIF) generated synergistic effects: an 18.7% reduction in incidence (95% UR: 5.6%-39.2%) and 33.1% reduction in TB mortality (95% UR: 18.1%-50.2%). By the end of year ten, combining same-day microscopy and Xpert MTB/RIF could reduce annual TB mortality by 44% relative to the current standard of care.Conclusion:Scaling up novel diagnostic tests for TB and optimizing existing ones are complementary strategies that, when combined, may have substantial impact on TB epidemics in Africa. © 2013 Dowdy et al.
Africa; article; automation; disease transmission; epidemic; human; Human immunodeficiency virus infection; incidence; infection prevention; intermethod comparison; laboratory device; major clinical study; mortality; MTB RIF test; pathogen load; population; same day microscopy; sputum cytodiagnosis; tuberculosis; world health organization; Africa; Diagnostic Tests, Routine; Humans; Incidence; Microscopy; Mortality; Mycobacterium tuberculosis; Reagent Kits, Diagnostic; Sensitivity and Specificity; Standard of Care; Tuberculosis