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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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Results of the Bayesian melding (resampling 20,000 parameter combinations from 2.28 million parameter combinations using the likelihood of the measured incidence as the weight). Box plot of estimates of the proportion of infections that were cured by 6 months of IPT (A), the protection provided by IPT against reinfection (B), and the impact of the intervention (C). The boxes reflect the interquartile range (IR), the “whiskers” extend to 1.5 times the IR, and the points outside this range are represented with filled circles. The resampling process resulted in 2,028 unique parameter combinations. HIV, human immunodeficiency virus; IPT, isoniazid preventive therapy.
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KWU320F5: Results of the Bayesian melding (resampling 20,000 parameter combinations from 2.28 million parameter combinations using the likelihood of the measured incidence as the weight). Box plot of estimates of the proportion of infections that were cured by 6 months of IPT (A), the protection provided by IPT against reinfection (B), and the impact of the intervention (C). The boxes reflect the interquartile range (IR), the “whiskers” extend to 1.5 times the IR, and the points outside this range are represented with filled circles. The resampling process resulted in 2,028 unique parameter combinations. HIV, human immunodeficiency virus; IPT, isoniazid preventive therapy.

Mentions: These findings were consistent across parameter values that were resampled using the likelihood of the incidence as the weight (Figure 5). The percentage of infections that were cured by 6 months of IPT was low for HIV-positive miners (median, 13.5%; 95% credible range, 0.7−66) but in a wide range for those who were HIV-negative (median, 55%; 95% credible range, 10–96), as was the IPT-derived protection against reinfection (median, 25%; 95% credible range, 0.4–75 for HIV-positive miners). The impact on the measured incidence and prevalence associated with these values was 14% (95% credible range, 11–17) and 9% (95% credible range, 6–12), respectively. Using the likelihood of the prevalence data as the weight gave similar findings (Web Figure 16).Figure 5.


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)

Results of the Bayesian melding (resampling 20,000 parameter combinations from 2.28 million parameter combinations using the likelihood of the measured incidence as the weight). Box plot of estimates of the proportion of infections that were cured by 6 months of IPT (A), the protection provided by IPT against reinfection (B), and the impact of the intervention (C). The boxes reflect the interquartile range (IR), the “whiskers” extend to 1.5 times the IR, and the points outside this range are represented with filled circles. The resampling process resulted in 2,028 unique parameter combinations. HIV, human immunodeficiency virus; IPT, isoniazid preventive therapy.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

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

KWU320F5: Results of the Bayesian melding (resampling 20,000 parameter combinations from 2.28 million parameter combinations using the likelihood of the measured incidence as the weight). Box plot of estimates of the proportion of infections that were cured by 6 months of IPT (A), the protection provided by IPT against reinfection (B), and the impact of the intervention (C). The boxes reflect the interquartile range (IR), the “whiskers” extend to 1.5 times the IR, and the points outside this range are represented with filled circles. The resampling process resulted in 2,028 unique parameter combinations. HIV, human immunodeficiency virus; IPT, isoniazid preventive therapy.
Mentions: These findings were consistent across parameter values that were resampled using the likelihood of the incidence as the weight (Figure 5). The percentage of infections that were cured by 6 months of IPT was low for HIV-positive miners (median, 13.5%; 95% credible range, 0.7−66) but in a wide range for those who were HIV-negative (median, 55%; 95% credible range, 10–96), as was the IPT-derived protection against reinfection (median, 25%; 95% credible range, 0.4–75 for HIV-positive miners). The impact on the measured incidence and prevalence associated with these values was 14% (95% credible range, 11–17) and 9% (95% credible range, 6–12), respectively. Using the likelihood of the prevalence data as the weight gave similar findings (Web Figure 16).Figure 5.

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