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Tuberculosis control in South African gold mines: mathematical modeling of a trial of community-wide isoniazid preventive therapy.

Vynnycky E, Sumner T, Fielding KL, Lewis JJ, Cox AP, Hayes RJ, Corbett EL, Churchyard GJ, Grant AD, White RG - Am. J. Epidemiol. (2015)

Bottom Line: A recent major cluster randomized trial of screening, active disease treatment, and mass isoniazid preventive therapy for 9 months during 2006-2011 among South African gold miners showed reduced individual-level tuberculosis incidence but no detectable population-level impact.We found the following: 1) The model suggests that a small proportion of latent infections among human immunodeficiency virus-positive people were cured, which could have been a key factor explaining the lack of detectable population-level impact. 2) The optimized implementation increased impact by only 10%. 3) Implementing additional interventions individually and in combination led to up to 30% and 75% reductions, respectively, in tuberculosis incidence after 10 years.Tuberculosis control requires a combination prevention approach, including health systems strengthening to minimize treatment delay, improving diagnostics, increased antiretroviral treatment coverage, and effective preventive treatment regimens.

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Schematic of the time course of the Thibela TB randomized controlled trial among South African gold miners, 2006–2011. TB, tuberculosis.
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KWU320F1: Schematic of the time course of the Thibela TB randomized controlled trial among South African gold miners, 2006–2011. TB, tuberculosis.

Mentions: The primary outcome was “tuberculosis incidence” in all clusters, measured during the “primary outcome measurement” period, lasting 12 months after the last person completed IPT in each cluster (Figure 1), with cases mainly ascertained from treatment records. Tuberculosis prevalence was measured by using culture confirmation among systematically sampled employees at the study's end.Figure 1.


Tuberculosis control in South African gold mines: mathematical modeling of a trial of community-wide isoniazid preventive therapy.

Vynnycky E, Sumner T, Fielding KL, Lewis JJ, Cox AP, Hayes RJ, Corbett EL, Churchyard GJ, Grant AD, White RG - Am. J. Epidemiol. (2015)

Schematic of the time course of the Thibela TB randomized controlled trial among South African gold miners, 2006–2011. TB, tuberculosis.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4388015&req=5

KWU320F1: Schematic of the time course of the Thibela TB randomized controlled trial among South African gold miners, 2006–2011. TB, tuberculosis.
Mentions: The primary outcome was “tuberculosis incidence” in all clusters, measured during the “primary outcome measurement” period, lasting 12 months after the last person completed IPT in each cluster (Figure 1), with cases mainly ascertained from treatment records. Tuberculosis prevalence was measured by using culture confirmation among systematically sampled employees at the study's end.Figure 1.

Bottom Line: A recent major cluster randomized trial of screening, active disease treatment, and mass isoniazid preventive therapy for 9 months during 2006-2011 among South African gold miners showed reduced individual-level tuberculosis incidence but no detectable population-level impact.We found the following: 1) The model suggests that a small proportion of latent infections among human immunodeficiency virus-positive people were cured, which could have been a key factor explaining the lack of detectable population-level impact. 2) The optimized implementation increased impact by only 10%. 3) Implementing additional interventions individually and in combination led to up to 30% and 75% reductions, respectively, in tuberculosis incidence after 10 years.Tuberculosis control requires a combination prevention approach, including health systems strengthening to minimize treatment delay, improving diagnostics, increased antiretroviral treatment coverage, and effective preventive treatment regimens.

View Article: PubMed Central - PubMed

Show MeSH
Related in: MedlinePlus