Abstract
Many high-burden countries have committed to providing universal access to rapid diagnosis of tuberculosis (TB), but the corresponding impact on population-wide incidence is unknown. We designed an agent-based simulation of drug-susceptible (DS) and drug-resistant (DR) TB in a representative Indian setting and compared the impact of Xpert testing via a decentralized (Xpert available at each local-population) versus centralized (Xpert available at the district-level serving multiple local-populations) strategy. Decentralized testing resulted in a 36% reduction in DR-TB incidence at 10 years compared to no Xpert. Depending on assumptions regarding pre-treatment loss to follow-up (ranging from 5 to 50%), the impact of centralized testing ranged from a 35% to 22% reduction in DR-TB incidence. Implementation of Xpert by either approach had a negligible impact (<5%) on DS-TB incidence. Decisions regarding choice of centralized vs. decentralized Xpert will heavily depend on operational aspects of centralized Xpert and loss to follow-up.
Original language | English (US) |
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Title of host publication | 2017 Winter Simulation Conference, WSC 2017 |
Publisher | Institute of Electrical and Electronics Engineers Inc. |
Pages | 1097-1108 |
Number of pages | 12 |
Volume | Part F134102 |
ISBN (Electronic) | 9781538634288 |
DOIs | |
State | Published - Jan 4 2018 |
Event | 2017 Winter Simulation Conference, WSC 2017 - Las Vegas, United States Duration: Dec 3 2017 → Dec 6 2017 |
Other
Other | 2017 Winter Simulation Conference, WSC 2017 |
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Country/Territory | United States |
City | Las Vegas |
Period | 12/3/17 → 12/6/17 |
ASJC Scopus subject areas
- Software
- Modeling and Simulation
- Computer Science Applications