Impact des nouveaux diagnostics de la tuberculose sur sa transmission: Pourquoi le contexte est important

Translated title of the contribution: The impact of new tuberculosis diagnostics on transmission: Why context matters

Hsien Ho Lin, David Wesley Dowdy, Christopher Dye, Megan Murray, Ted Cohen

Research output: Contribution to journalArticle

Abstract

Objective To estimate the impact of new tuberculosis diagnostics on tuberculosis transmission given the complex contextual factors that can lead to patient loss before diagnosis or treatment. Methods An epidemic model of tuberculosis specifying discrete steps along the tuberculosis diagnostic pathway was constructed. The model was calibrated to the epidemiology of tuberculosis and human immunodeficiency virus (HIV) infection in the United Republic of Tanzania and was used to assess the impact of a new diagnostic tool with 70% sensitivity for smear-negative pulmonary tuberculosis. The influence of contextual factors on the projected epidemic impact of the new diagnostic tool over the decade following introduction was explored. Findings With the use of smear microscopy, the incidence of tuberculosis will decline by an average of 3.94% per year. If the new tool is added, incidence will decline by an annual 4.25%. This represents an absolute change of 0.31 percentage points (95% confidence interval: 0.04-0.42). However, the annual decline in transmission with use of the new tool is less when existing strategies for the diagnosis of smearnegative cases have high sensitivity and when symptomatic individuals delay in seeking care. Other influential contextual factors include access to tuberculosis care, patient loss before diagnosis, initial patient default after diagnosis and treatment success rate. Conclusion When implementing and scaling up the use of a new diagnostic tool, the operational context in which diagnosis and treatment take place needs to be considered.

Original languageFrench
JournalBulletin of the World Health Organization
Volume90
Issue number10
DOIs
StatePublished - Oct 2012

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Tuberculosis
Tanzania
Incidence
Virus Diseases
Pulmonary Tuberculosis
Microscopy
Patient Care
Epidemiology
Therapeutics
HIV
Confidence Intervals

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Impact des nouveaux diagnostics de la tuberculose sur sa transmission : Pourquoi le contexte est important. / Lin, Hsien Ho; Dowdy, David Wesley; Dye, Christopher; Murray, Megan; Cohen, Ted.

In: Bulletin of the World Health Organization, Vol. 90, No. 10, 10.2012.

Research output: Contribution to journalArticle

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