Evaluation of tuberculosis control policies using computer simulation.

T F Brewer; S J Heymann; G A Colditz; M E Wilson; K Auerbach; D Kane; H V Fineberg

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PubMed · 8968016

Evaluation of tuberculosis control policies using computer simulation.

T F Brewer·S J Heymann·G A Colditz·M E Wilson·K Auerbach·D Kane·H V Fineberg

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Abstract

OBJECTIVE: To develop more effective methods to assess tuberculosis (TB) control strategies so we can meet national goals for the elimination of TB in the United States. DESIGN: Using a semi-Markov model that divided the US population into 3 age groups and 18 clinical states based on disease status and risk for TB and human immunodeficiency virus (HIV) infection, we measured the effects of 5 changes in TB policy, introduced singly and in combination: (1) increased coverage and (2) improved efficacy of preventive therapy, (3) increased coverage and (4) improved efficacy of treatment, and (5) introduction of BCG vaccination. RESULTS: A BCG vaccination program that reached 10% of eligible children and 1% of eligible adults each year would produce a 17% reduction in cases and an 11% decline in deaths over 10 years. Preventive therapy programs among the general population would have little effect on the number of TB cases, but a program targeting HIV-infected patients would reduce HIV-associated TB cases and deaths 14% to 20%. A 10% improvement in the coverage and efficacy of both preventive therapy and treatment, coupled with the BCG vaccination program, would lead to a 47% decline in TB cases and a 50% decline in TB deaths relative to baseline over 10 years. CONCLUSIONS: Improvements in treatment coverage or effectiveness alone are unlikely to reach established national goals for the elimination of TB. These goals can be achieved through a combination of improvements in current programs with targeted preventive therapy and BCG vaccination programs.

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Adolescent Adult Age Distribution Antitubercular Agents BCG Vaccine Child Communicable Disease Control HIV Infections Humans Middle Aged Models, Theoretical Policy Making Probability Tuberculosis Tuberculosis, Multidrug-Resistant United States Journal Article Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S.

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T F Brewer, S J Heymann, G A Colditz, M E Wilson, K Auerbach, D Kane, H V Fineberg. 1996-12-18. Evaluation of tuberculosis control policies using computer simulation.. https://pubmed.ncbi.nlm.nih.gov/8968016/

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