Imperial College London
Alternate

Professor Nimalan Arinaminpathy (Nim Pathy)

Faculty of Medicine, School of Public Health

Professor in Mathematical Epidemiology
 
 
 
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Contact

 

nim.pathy Website

 
 
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Location

 

Praed StreetSt Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Sachdeva:2015:10.1371/journal.pone.0131438,
author = {Sachdeva, KS and Raizada, N and Gupta, RS and Nair, SA and Denkinger, C and Paramasivan, CN and Kulsange, S and Thakur, R and Dewan, P and Boehme, C and Arinaminpathy, N},
doi = {10.1371/journal.pone.0131438},
journal = {PLOS One},
title = {The potential impact of up-front drug sensitivity testing on India's epidemic of multi-drug resistant tuberculosis},
url = {http://dx.doi.org/10.1371/journal.pone.0131438},
volume = {10},
year = {2015}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BackgroundIn India as elsewhere, multi-drug resistance (MDR) poses a serious challenge in the control of tuberculosis (TB). The End TB strategy, recently approved by the world health assembly, aims to reduce TB deaths by 95% and new cases by 90% between 2015 and 2035. A key pillar of this approach is early diagnosis of tuberculosis, including use of higher-sensitivity diagnostic testing and universal rapid drug susceptibility testing (DST). Despite limitations of current laboratory assays, universal access to rapid DST could become more feasible with the advent of new and emerging technologies. Here we use a mathematical model of TB transmission, calibrated to the TB epidemic in India, to explore the potential impact of a major national scale-up of rapid DST. To inform key parameters in a clinical setting, we take GeneXpert as an example of a technology that could enable such scale-up. We draw from a recent multi-centric demonstration study conducted in India that involved upfront Xpert MTB/RIF testing of all TB suspects.ResultsWe find that widespread, public-sector deployment of high-sensitivity diagnostic testing and universal DST appropriately linked with treatment could substantially impact MDR-TB in India. Achieving 75% access over 3 years amongst all cases being diagnosed for TB in the public sector alone could avert over 180,000 cases of MDR-TB (95% CI 44187 – 317077 cases) between 2015 and 2025. Sufficiently wide deployment of Xpert could, moreover, turn an increasing MDR epidemic into a diminishing one. Synergistic effects were observed with assumptions of simultaneously improving MDR-TB treatment outcomes. Our results illustrate the potential impact of new and emerging technologies that enable widespread, timely DST, and the important effect that universal rapid DST in the public sector can have on the MDR-TB epidemic in India.
AU  - Sachdeva,KS
AU  - Raizada,N
AU  - Gupta,RS
AU  - Nair,SA
AU  - Denkinger,C
AU  - Paramasivan,CN
AU  - Kulsange,S
AU  - Thakur,R
AU  - Dewan,P
AU  - Boehme,C
AU  - Arinaminpathy,N
DO  - 10.1371/journal.pone.0131438
PY  - 2015///
SN  - 1932-6203
TI  - The potential impact of up-front drug sensitivity testing on India's epidemic of multi-drug resistant tuberculosis
T2  - PLOS One
UR  - http://dx.doi.org/10.1371/journal.pone.0131438
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000358153000118&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - http://hdl.handle.net/10044/1/51061
VL  - 10
ER  -
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