For Publishers
DiscoveryMetadataPeer reviewHostingPublishing
For Researchers
JoinPublishReviewCollect
Register
Blog
About
Search
Advanced search
My ScienceOpen
Search
For Publishers
For Researchers
Blog
About
14
views
31
references
 Top references
cited by
16
    
0 reviews
 Review
0
comments
 Comment
0
recommends
+1 Recommend
0 collections
    0
    shares
      112
      similar
       All similar
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Counting the lives saved by DOTS in India: a model-based approach

      research-article

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          Against the backdrop of renewed efforts to control tuberculosis (TB) worldwide, there is a need for improved methods to estimate the public health impact of TB programmes. Such methods should not only address the improved outcomes amongst those receiving care but should also account for the impact of TB services on reducing transmission.

          Methods

          Vital registration data in India are not sufficiently reliable for estimates of TB mortality. As an alternative approach, we developed a mathematical model of TB transmission dynamics and mortality, capturing the scale-up of DOTS in India, through the rollout of the Revised National TB Control Programme (RNTCP). We used available data from the literature to calculate TB mortality hazards amongst untreated TB; amongst cases treated under RNTCP; and amongst cases treated under non-RNTCP conditions. Using a Bayesian evidence synthesis framework, we combined these data with current estimates for the TB burden in India to calibrate the transmission model. We simulated the national TB epidemic in the presence and absence of the DOTS programme, measuring lives saved as the difference in TB deaths between these scenarios.

          Results

          From 1997 to 2016, India’s RNTCP has saved 7.75 million lives (95% Bayesian credible interval 6.29–8.82 million). We estimate that 42% of this impact was due to the ‘indirect’ effects of the RNTCP in averting transmission as well as improving treatment outcomes.

          Conclusions

          When expanding high-quality TB services, a substantial proportion of overall impact derives from preventive, as well as curative, benefits. Mathematical models, together with sufficient data, can be a helpful tool in estimating the true population impact of major disease control programmes.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12916-017-0809-5) contains supplementary material, which is available to authorized users.

          Related collections

          Most cited references31

          • Record: found
          • Abstract: found
          • Article: not found

          Tuberculosis prevalence in China, 1990-2010; a longitudinal analysis of national survey data.

          Lixia Wang, Hui Zhang, Yunzhou Ruan … (2014)
          China scaled up a tuberculosis control programme (based on the directly observed treatment, short-course [DOTS] strategy) to cover half the population during the 1990s, and to the entire population after 2000. We assessed the effect of the programme. In this longitudinal analysis, we compared data from three national tuberculosis prevalence surveys done in 1990, 2000, and 2010. The 2010 survey screened 252,940 eligible individuals aged 15 years and older at 176 investigation points, chosen by stratified random sampling from all 31 mainland provinces. All individuals had chest radiographs taken. Those with abnormal radiographs, persistent cough, or both, were classified as having suspected tuberculosis. Tuberculosis was diagnosed by chest radiograph, sputum-smear microscopy, and culture. Trained staff interviewed each patient with tuberculosis. The 1990 and 2000 surveys were reanalysed and compared with the 2010 survey. From 1990 to 2010, the prevalence of smear-positive tuberculosis decreased from 170 cases (95% CI 166-174) to 59 cases (49-72) per 100,000 population. During the 1990s, smear-positive prevalence fell only in the provinces with the DOTS programme; after 2000, prevalence decreased in all provinces. The percentage reduction in smear-positive prevalence was greater for the decade after 2000 than the decade before (57% vs 19%; p<0.0001). 70% of the total reduction in smear-positive prevalence (78 of 111 cases per 100,000 population) occurred after 2000. Of these cases, 68 (87%) were in known cases-ie, cases diagnosed with tuberculosis before the survey. Of the known cases, the proportion treated by the public health system (using the DOTS strategy) increased from 59 (15%) of 370 cases in 2000 to 79 (66%) of 123 cases in 2010, contributing to reduced proportions of treatment default (from 163 [43%] of 370 cases to 35 [22%] of 123 cases) and retreatment cases (from 312 [84%] of 374 cases to 48 [31%] of 137 cases; both p<0.0001). In 20 years, China more than halved its tuberculosis prevalence. Marked improvement in tuberculosis treatment, driven by a major shift in treatment from hospitals to the public health centres (that implemented the DOTS strategy) was largely responsible for this epidemiological effect. Chinese Ministry of Health. Copyright © 2014 Elsevier Ltd. All rights reserved.
          Article 0 comments Cited 264 times – based on 0 reviews     Review now
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            The population dynamics and control of tuberculosis.

            Christopher Dye, Brian Williams (2010)
            More than 36 million patients have been successfully treated via the World Health Organization's strategy for tuberculosis (TB) control since 1995. Despite predictions of a decline in global incidence, the number of new cases continues to grow, approaching 10 million in 2010. Here we review the changing relationship between the causative agent, Mycobacterium tuberculosis, and its human host and examine a range of factors that could explain the persistence of TB. Although there are ways to reduce susceptibility to infection and disease, and a high-efficacy vaccine would boost TB prevention, early diagnosis and drug treatment to interrupt transmission remain the top priorities for control. Whatever the technology used, success depends critically on the social, institutional, and epidemiological context in which it is applied.
            Article 0 comments Cited 182 times – based on 0 reviews     Review now
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              HIV infection and tuberculosis in South Africa: an urgent need to escalate the public health response.

              Salim S Abdool Karim, Gavin Churchyard, Quarraisha Karim … (2009)
              One of the greatest challenges facing post-apartheid South Africa is the control of the concomitant HIV and tuberculosis epidemics. HIV continues to spread relentlessly, and tuberculosis has been declared a national emergency. In 2007, South Africa, with 0.7% of the world's population, had 17% of the global burden of HIV infection, and one of the world's worst tuberculosis epidemics, compounded by rising drug resistance and HIV co-infection. Until recently, the South African Government's response to these diseases has been marked by denial, lack of political will, and poor implementation of policies and programmes. Nonetheless, there have been notable achievements in disease management, including substantial improvements in access to condoms, expansion of tuberculosis control efforts, and scale-up of free antiretroviral therapy (ART). Care for acutely ill AIDS patients and long-term provision of ART are two issues that dominate medical practice and the health-care system. Decisive action is needed to implement evidence-based priorities for the control of the HIV and tuberculosis epidemics. By use of the framework of the Strategic Plans for South Africa for tuberculosis and HIV/AIDS, we provide prioritised four-step approaches for tuberculosis control, HIV prevention, and HIV treatment. Strong leadership, political will, social mobilisation, adequate human and financial resources, and sustainable development of health-care services are needed for successful implementation of these approaches.
              Article 0 comments Cited 163 times – based on 0 reviews     Review now
                Bookmark
                All references

                Author and article information

                Contributors
                Sandip Mandal: sandip.mandal@phfi.org
                Vineet K. Chadha: vineet2.chadha@gmail.com
                Ramanan Laxminarayan: ramanan@cddep.org
                Nimalan Arinaminpathy: nim.pathy@imperial.ac.uk
                Journal
                Journal ID (nlm-ta): BMC Med
                Journal ID (iso-abbrev): BMC Med
                Title: BMC Medicine
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1741-7015
                Publication date (Electronic): 3 March 2017
                Publication date PMC-release: 3 March 2017
                Publication date Collection: 2017
                Volume: 15
                Electronic Location Identifier: 47
                Affiliations
                [1 ]ISNI 0000 0004 1761 0198, GRID grid.415361.4, , Public Health Foundation of India, ; New Delhi, India
                [2 ]ISNI 0000 0004 1768 4744, GRID grid.419776.a, Epidemiology and Research Division, , National Tuberculosis Institute, ; Bangalore, India
                [3 ]GRID grid.452324.6, , Center for Disease Dynamics, Economics, and Policy, ; Washington, DC USA
                [4 ]ISNI 0000 0001 2097 5006, GRID grid.16750.35, , Princeton University, ; Princeton, NJ USA
                [5 ]ISNI 0000 0001 2113 8111, GRID grid.7445.2, Department of Infectious Disease Epidemiology, Faculty of Medicine, , Imperial College, ; London, UK
                Article
                Publisher ID: 809
                DOI: 10.1186/s12916-017-0809-5
                PMC ID: 5335816
                PubMed ID: 28253922
                SO-VID: 6dbac544-7d2e-4d56-aab8-a3ab76ad7341
                Copyright © © The Author(s). 2017
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 18 October 2016
                Date accepted : 6 February 2017
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000865, Bill and Melinda Gates Foundation;
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2017

                ScienceOpen disciplines: Medicine
                Keywords: india,tuberculosis,modelling,deaths averted
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: india, tuberculosis, modelling, deaths averted

                Comments

                Comment on this article

                scite_

                Similar content112

                See all similar

                Cited by16

                See all cited by

                Most referenced authors299

                See all reference authors