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Tuberculosis control in China: use of modelling to develop targets and policies.

Lin HH, Wang L, Zhang H, Ruan Y, Chin DP, Dye C - Bull. World Health Organ. (2015)

Bottom Line: However, reductions in the incidence of multidrug-resistant tuberculosis should be feasible.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Rm706, No.17 Xuzhou Rd, Taipei 100, Taiwan, China .

ABSTRACT
It is unclear if current programmes in China can achieve the post-2015 global targets for tuberculosis - 50% reduction in incidence and a 75% reduction in mortality by 2025. Chinese policy-makers need to maintain the recent decline in the prevalence of tuberculosis, while revising control policies to cope with an epidemic of drug-resistant tuberculosis and the effects of ongoing health reform. Health reforms are expected to shift patients from tuberculosis dispensaries to designated hospitals. We developed a mathematical model of tuberculosis control in China to help set appropriate targets and prioritize interventions that might be implemented in the next 10 years. This model indicates that, even under the most optimistic scenario - improved treatment in tuberculosis dispensaries, introduction of a new effective regimen for the treatment of drug-susceptible tuberculosis and optimal care of cases of multidrug-resistant tuberculosis - the current global targets for tuberculosis are unlikely to be reached. However, reductions in the incidence of multidrug-resistant tuberculosis should be feasible. We conclude that a shift of patients from tuberculosis dispensaries to designated hospitals is likely to hamper efforts at tuberculosis control if cure rates in the designated hospitals cannot be maintained at a high level. Our results can inform the planning of tuberculosis control in China.

No MeSH data available.


Related in: MedlinePlus

Projected impact of different scenarios of tuberculosis control on multidrug resistance among patients with tuberculosis, China, 2015–2025
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Figure 6: Projected impact of different scenarios of tuberculosis control on multidrug resistance among patients with tuberculosis, China, 2015–2025

Mentions: Under scenario 1, the absolute prevalence of MDR tuberculosis in the general population would be expected to decline over time – e.g. by 20.3% (95% CrI: 5.8 to 27.8%) by 2025 (Fig. 5). This decline would be mainly driven by the overall general decline in tuberculosis prevalence (Fig. 2) since the proportion of MDR tuberculosis would remain largely unchanged (Fig. 6). Improvement in the treatment outcomes for drug-susceptible tuberculosis and provision of diagnosis and treatment for MDR tuberculosis would further decrease the prevalence of MDR tuberculosis in the general population. In Scenario 5, the combination of system change, new treatment regimen and new technology would bring the greatest reduction in MDR tuberculosis prevalence in the general population of any of the modelled scenarios: a 74.6% (95% CrI: 62.6 to 80.8%) reduction between 2015 and 2025.


Tuberculosis control in China: use of modelling to develop targets and policies.

Lin HH, Wang L, Zhang H, Ruan Y, Chin DP, Dye C - Bull. World Health Organ. (2015)

Projected impact of different scenarios of tuberculosis control on multidrug resistance among patients with tuberculosis, China, 2015–2025
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4622160&req=5

Figure 6: Projected impact of different scenarios of tuberculosis control on multidrug resistance among patients with tuberculosis, China, 2015–2025
Mentions: Under scenario 1, the absolute prevalence of MDR tuberculosis in the general population would be expected to decline over time – e.g. by 20.3% (95% CrI: 5.8 to 27.8%) by 2025 (Fig. 5). This decline would be mainly driven by the overall general decline in tuberculosis prevalence (Fig. 2) since the proportion of MDR tuberculosis would remain largely unchanged (Fig. 6). Improvement in the treatment outcomes for drug-susceptible tuberculosis and provision of diagnosis and treatment for MDR tuberculosis would further decrease the prevalence of MDR tuberculosis in the general population. In Scenario 5, the combination of system change, new treatment regimen and new technology would bring the greatest reduction in MDR tuberculosis prevalence in the general population of any of the modelled scenarios: a 74.6% (95% CrI: 62.6 to 80.8%) reduction between 2015 and 2025.

Bottom Line: However, reductions in the incidence of multidrug-resistant tuberculosis should be feasible.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Rm706, No.17 Xuzhou Rd, Taipei 100, Taiwan, China .

ABSTRACT
It is unclear if current programmes in China can achieve the post-2015 global targets for tuberculosis - 50% reduction in incidence and a 75% reduction in mortality by 2025. Chinese policy-makers need to maintain the recent decline in the prevalence of tuberculosis, while revising control policies to cope with an epidemic of drug-resistant tuberculosis and the effects of ongoing health reform. Health reforms are expected to shift patients from tuberculosis dispensaries to designated hospitals. We developed a mathematical model of tuberculosis control in China to help set appropriate targets and prioritize interventions that might be implemented in the next 10 years. This model indicates that, even under the most optimistic scenario - improved treatment in tuberculosis dispensaries, introduction of a new effective regimen for the treatment of drug-susceptible tuberculosis and optimal care of cases of multidrug-resistant tuberculosis - the current global targets for tuberculosis are unlikely to be reached. However, reductions in the incidence of multidrug-resistant tuberculosis should be feasible. We conclude that a shift of patients from tuberculosis dispensaries to designated hospitals is likely to hamper efforts at tuberculosis control if cure rates in the designated hospitals cannot be maintained at a high level. Our results can inform the planning of tuberculosis control in China.

No MeSH data available.


Related in: MedlinePlus