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