93 results found
Silva S, Arinaminpathy N, Atun R, et al., 2021, Economic impact of tuberculosis mortality in 120 countries and the cost of not achieving the Sustainable Development Goals tuberculosis targets: a full-income analysis., Lancet Glob Health
BACKGROUND: The tuberculosis targets for the UN Sustainable Development Goals (SDGs) call for a 90% reduction in tuberculosis deaths by 2030, compared with 2015, but meeting this target now seems highly improbable. To assess the economic impact of not meeting the target until 2045, we estimated full-income losses in 120 countries, including those due to excess deaths resulting from COVID-19-related disruptions to tuberculosis services, for the period 2020-50. METHODS: Annual mortality risk changes at each age in each year from 2020 to 2050 were estimated for 120 countries. This risk change was then converted to full-income risk by calculating a population-level mortality risk change and multiplying it by the value of a statistical life-year in each country and year. As a comparator, we assumed that current rates of tuberculosis continue to decline through the period of analysis. We calculated the full-income losses, and mean life expectancy losses per person, at birth and at age 35 years, under scenarios in which the SDG targets are met in 2030 and in 2045. We defined the cost of inaction as the difference in full-income losses and tuberculosis mortality between these two scenarios. FINDINGS: From 2020 to 2050, based on the current annual decrease in tuberculosis deaths of 2%, 31·8 million tuberculosis deaths (95% uncertainty interval 25·2 million-39·5 million) are estimated to occur, corresponding to an economic loss of US$17·5 trillion (14·9 trillion-20·4 trillion). If the SDG tuberculosis mortality target is met in 2030, 23·8 million tuberculosis deaths (18·9 million-29·5 million) and $13·1 trillion (11·2 trillion-15·3 trillion) in economic losses can be avoided. If the target is met in 2045, 18·1 million tuberculosis deaths (14·3 million-22·4 million) and $10·2 trillion (8·7 trillion-11·8 trillion) can be avoided. The cost of inaction of
Mandal S, Arinaminpathy N, Bhargava B, et al., 2021, Responsive and agile vaccination strategies against COVID-19 in India., Lancet Glob Health, Vol: 9, Pages: e1197-e1200
Arinaminpathy N, Das J, McCormick T, et al., 2021, Quantifying heterogeneity in SARS-CoV-2 transmission during the lockdown in India, Epidemics: the journal of infectious disease dynamics, Vol: 36, Pages: 1-7, ISSN: 1755-4365
The novel SARS-CoV-2 virus, as it manifested in India in April 2020, showed marked heterogeneity in its transmission. Here, we used data collected from contact tracing during the lockdown in response to the first wave of COVID-19 in Punjab, a major state in India, to quantify this heterogeneity, and to examine implications for transmission dynamics. We found evidence of heterogeneity acting at multiple levels: in the number of potentially infectious contacts per index case, and in the per-contact risk of infection. Incorporating these findings in simple mathematical models of disease transmission reveals that these heterogeneities act in combination to strongly influence transmission dynamics. Standard approaches, such as representing heterogeneity through secondary case distributions, could be biased by neglecting these underlying interactions between heterogeneities. We discuss implications for policy, and for more efficient contact tracing in resource-constrained settings such as India. Our results highlight how contact tracing, an important public health measure, can also provide important insights into epidemic spread and control.
Arinaminpathy N, Nandi A, Shibu V, et al., 2021, Engaging with the private healthcare sector for the control of tuberculosis in India: Cost and cost-effectiveness, BMJ Global Health, ISSN: 2059-7908
BackgroundThe control of tuberculosis (TB) in India is complicated by the presence of a large, disorganised private sector where most patients first seek care. Following pilots in Mumbai and Patna (two major cities in India), an initiative known as the ‘Public Private Interface Agency’ (PPIA) is now being expanded across the country. We aimed to estimate the cost-effectiveness of scaling up PPIA operations, in line with India’s National Strategic Plan for TB control.MethodsFocusing on Mumbai and Patna, we collected cost data from implementing organisations in both cities and combined this data with models of TB transmission dynamics. Estimating the cost per DALY averted between 2014 (the start of PPIA scale-up) and 2025, we assessed cost-effectiveness using two willingness-to-pay approaches: a WHO-CHOICE threshold based on per-capita economic productivity, and a more stringent threshold incorporating opportunity costs in the health system.FindingsA PPIA scaled up to ultimately reach 50% of privately-treated TB patients in Mumbai and Patna would cost, respectively, USD 228 (95% C.I. 159 – 320) per DALY averted and USD 564 (95% C.I. 409 - 775) per DALY averted. In Mumbai, the PPIA would be cost-effective relative to all thresholds considered. In Patna, if focusing on adherence support, rather than on improved diagnosis, the PPIA would be cost-effective relative to all thresholds considered. These differences between sites arise from variations in the burden of drug resistance: amongst the services of a PPIA, improved diagnosis (including rapid tests with genotypic drug sensitivity testing) has greatest value in settings such as Mumbai, with a high burden of drug-resistant TB.ConclusionsTo accelerate decline in TB incidence, it is critical first to engage effectively with the private sector in India. Mechanisms such as the PPIA offer cost-effective ways of doing so, particularly when tailored to local settings.
Kendall EA, Arinaminpathy N, Sacks JA, et al., 2021, Antigen-based rapid diagnostic testing or alternatives for diagnosis of symptomatic COVID-19: A simulation-based net benefit analysis., Epidemiology
BACKGROUND: SARS-CoV-2 antigen-detection rapid diagnostic tests can diagnose COVID-19 rapidly and at low cost, but lower sensitivity compared with reverse-transcriptase polymerase chain reaction (PCR) has limited clinical adoption. METHODS: We compared antigen testing, PCR testing, and clinical judgment alone for diagnosing symptomatic COVID-19 in an outpatient setting (10% COVID-19 prevalence among the patients tested, 3-day PCR turnaround) and a hospital setting (40% prevalence, 24-hour PCR turnaround). We simulated transmission from cases and contacts, and relationships between time, viral burden, transmission, and case detection. We compared diagnostic approaches using a measure of net benefit that incorporated both clinical and public health benefits and harms of intervention. RESULTS: In the outpatient setting, we estimated that using antigen testing instead of PCR to test 200 individuals could be equivalent to preventing all symptomatic transmission from one person with COVID-19 (one "transmission-equivalent"). In a hospital, net benefit analysis favored PCR, and testing 25 patients with PCR instead of antigen testing achieved one transmission-equivalent of benefit. In both settings, antigen testing was preferable to PCR if PCR turnaround time exceeded 2 days. Both tests provided greater net benefit than management based on clinical judgment alone, unless intervention carried minimal harm and was provided equally regardless of diagnostic approach. CONCLUSIONS: For diagnosis of symptomatic COVID-19, we estimated that speed of diagnosis with antigen testing is likely to outweigh its lower accuracy compared to PCR wherever PCR turnaround time is 2 days or longer. This advantage may be even greater if antigen tests are also less expensive.
Mandal S, Arinaminpathy N, Bhargava B, et al., 2021, India's pragmatic vaccination strategy against COVID-19: a mathematical modelling-based analysis., BMJ Open, Vol: 11
OBJECTIVES: To investigate the impact of targeted vaccination strategies on morbidity and mortality due to COVID-19, as well as on the incidence of SARS-CoV-2, in India. DESIGN: Mathematical modelling. SETTINGS: Indian epidemic of COVID-19 and vulnerable population. DATA SOURCES: Country-specific and age-segregated pattern of social contact, case fatality rate and demographic data obtained from peer-reviewed literature and public domain. MODEL: An age-structured dynamical model describing SARS-CoV-2 transmission in India incorporating uncertainty in natural history parameters was constructed. INTERVENTIONS: Comparison of different vaccine strategies by targeting priority groups such as keyworkers including healthcare professionals, individuals with comorbidities (24-60 years old) and all above 60. MAIN OUTCOME MEASURES: Incidence reduction and averted deaths in different scenarios, assuming that the current restrictions are fully lifted as vaccination is implemented. RESULTS: The priority groups together account for about 18% of India's population. An infection-preventing vaccine with 60% efficacy covering all these groups would reduce peak symptomatic incidence by 20.6% (95% uncertainty intervals (UI) 16.7-25.4) and cumulative mortality by 29.7% (95% CrI 25.8-33.8). A similar vaccine with ability to prevent symptoms (but not infection) will reduce peak incidence of symptomatic cases by 10.4% (95% CrI 8.4-13.0) and cumulative mortality by 32.9% (95% CrI 28.6-37.3). In the event of insufficient vaccine supply to cover all priority groups, model projections suggest that after keyworkers, vaccine strategy should prioritise all who are >60 and subsequently individuals with comorbidities. In settings with weakest transmission, such as sparsely populated rural areas, those with comorbidities should be prioritised after keyworkers. CONCLUSIONS: An appropriately targeted vaccination strategy would witness substantial mitigation of impact of COVID-19 in a country l
Mandal S, Arinaminpathy N, Bhargava B, et al., 2021, Plausibility of a third wave of COVID-19 in India: A mathematical modelling based analysis., Indian J Med Res, ISSN: 0971-5916
Background & objectives: : In the context of India's ongoing resurgence of COVID-19 (second wave since mid-February 2021, following the subsiding of the first wave in September 2020), there has been increasing speculation on the possibility of a future third wave of infection, posing a burden on the healthcare system. Using simple mathematical models of the transmission dynamics of SARS-CoV-2, this study examined the conditions under which a serious third wave could occur. Methods: : Using a deterministic, compartmental model of SARS-CoV-2 transmission, four potential mechanisms for a third wave were examined: (i) waning immunity restores previously exposed individuals to a susceptible state, (ii) emergence of a new viral variant that is capable of escaping immunity to previously circulating strains, (iii) emergence of a new viral variant that is more transmissible than the previously circulating strains, and (iv) release of current lockdowns affording fresh opportunities for transmission. Results: : Immune-mediated mechanisms (waning immunity, or viral evolution for immune escape) are unlikely to drive a severe third wave if acting on their own, unless such mechanisms lead to a complete loss of protection among those previously exposed. Likewise, a new, more transmissible variant would have to exceed a high threshold (R0>4.5) to cause a third wave on its own. However, plausible mechanisms for a third wave include: (i) a new variant that is more transmissible and at the same time capable of escaping prior immunity, and (ii) lockdowns that are highly effective in limiting transmission and subsequently released. In both cases, any third wave seems unlikely to be as severe as the second wave. Rapid scale-up of vaccination efforts could play an important role in mitigating these and future waves of the disease. Interpretation & conclusions: : This study demonstrates plausible mechanisms by which a substantial third wave could occur, while also illustrating th
Ricks S, Kendall EA, Dowdy DW, et al., 2021, Quantifying the potential value of antigen-detection rapid diagnostic tests for COVID-19: a modelling analysis, BMC Medicine, Vol: 19, Pages: 1-13, ISSN: 1741-7015
BackgroundTesting plays a critical role in treatment and prevention responses to the COVID-19 pandemic. Compared to nucleic acid tests (NATs), antigen-detection rapid diagnostic tests (Ag-RDTs) can be more accessible, but typically have lower sensitivity and specificity. By quantifying these trade-offs, we aimed to inform decisions about when an Ag-RDT would offer greater public health value than reliance on NAT. MethodsFollowing an expert consultation, we selected two use cases for analysis: rapid identification of people with COVID-19 amongst patients admitted with respiratory symptoms in a ‘hospital’ setting; and early identification and isolation of people with mildly symptomatic COVID-19 in a ‘community’ setting. Using decision analysis, we evaluated the health system cost and health impact (deaths averted and infectious days isolated) of an Ag-RDT-led strategy, compared to a strategy based on NAT and clinical judgment. We adopted a broad range of values for ‘contextual’ parameters relevant to a range of settings, including the availability of NAT, the performance of clinical judgement, etc. We performed a multivariate sensitivity analysis to all of these parameters. ResultsIn a hospital setting, an Ag-RDT-led strategy would avert more deaths than a NAT-based strategy, and at lower cost per death averted, when the sensitivity of clinical judgement is less than 85%, and when NAT results are available in time to inform clinical decision-making for less than 90% of patients. The use of an Ag-RDT is robustly supported in community settings, where it would avert more transmission at lower cost than relying on NAT alone, under a wide range of assumptions. ConclusionsDespite their imperfect sensitivity and specificity, Ag-RDTs have the potential to be simultaneously more impactful, and have a lower cost per death and infectious person-days averted, than current approaches to COVID-19 diagnostic testing.
Mandal S, Das H, Deo S, et al., 2021, Combining serology with case-detection, to allow the easing of restrictions against SARS-CoV-2: a modelling-based study in India, Scientific Reports, Vol: 11, Pages: 1-9, ISSN: 2045-2322
India’s lockdown against SARS-CoV-2, if lifted without any other mitigations in place, could risk a second wave of infection. A test-and-isolate strategy, using PCR diagnostic tests, could help to minimise the impact of this second wave. Meanwhile, population-level serological surveillance can provide valuable insights into the level of immunity in the population. Using a mathematical model, consistent with an Indian megacity, we examined how seroprevalence data could guide a test-and-isolate strategy, for lifting a lockdown. For example, if seroprevalence is 20% of the population, we show that a testing strategy needs to identify symptomatic cases within 5 – 8 days of symptom onset, in order to prevent a resurgent wave from overwhelming hospital capacity in the city. This estimate is robust to uncertainty in the effectiveness of the lockdown, as well as in immune protection against reinfection. To set these results in their economic context, we estimate that the weekly cost of such a PCR-based testing programme would be less than 2.1% of the weekly economic loss due to the lockdown. Our results illustrate how PCR-based testing and serological surveillance can be combined to design evidence-based policies, for lifting lockdowns in Indian cities and elsewhere.
Fu H, Lewnard JA, Frost I, et al., 2021, Modelling the global burden of drug-resistant tuberculosis avertable by a post-exposure vaccine, Nature Communications, Vol: 12, Pages: 1-9, ISSN: 2041-1723
There have been notable advances in the development of vaccines against active tuberculosis (TB) disease for adults and adolescents. Using mathematical models, we seek to estimate the potential impact of a post-exposure TB vaccine, having 50% efficacy in reducing active disease, on global rifampicin-resistant (RR-) TB burden. In 30 countries that together accounted for 90% of global RR-TB incidence in 2018, a future TB vaccine could avert 10% (95% credible interval: 9.7–11%) of RR-TB cases and 7.3% (6.6–8.1%) of deaths over 2020–2035, with India, China, Indonesia, Pakistan, and the Russian Federation having the greatest contribution. This impact would increase to 14% (12–16%) and 31% (29–33%) respectively, when combined with improvements in RR-TB diagnosis and treatment relative to a scenario of no vaccine and no such improvements. A future TB vaccine could have important implications for the global control of RR-TB, especially if implemented alongside enhancements in management of drug resistance.
Ricks S, Denkinger CM, Schumacher SG, et al., 2020, The potential impact of urine-LAM diagnostics on tuberculosis incidence and mortality: a modelling analysis, PLoS Medicine, Vol: 17, ISSN: 1549-1277
BackgroundLateral flow urine lipoarabinomannan (LAM) tests could offer important new opportunities for the early detection of tuberculosis (TB). The currently licensed LAM test, Alere Determine TB LAM Ag (‘LF-LAM’), performs best in the sickest people living with HIV (PLHIV). However, the technology continues to improve, with newer LAM tests, such as Fujifilm SILVAMP TB LAM (‘SILVAMP-LAM’) showing improved sensitivity, including amongst HIV-negative patients. It is important to anticipate the epidemiological impact that current and future LAM tests may have on TB incidence and mortality.Methods and findingsConcentrating on South Africa, we examined the impact that widening LAM test eligibility would have on TB incidence and mortality. We developed a mathematical model of TB transmission to project the impact of LAM tests, distinguishing ‘current’ tests (with sensitivity consistent with LF-LAM), from hypothetical ‘future’ tests (having sensitivity consistent with SILVAMP-LAM). We modelled the impact of both tests, assuming full adoption of the 2019 WHO guidelines for the use of these tests amongst those receiving HIV care. We also simulated the hypothetical deployment of future LAM tests for all people presenting to care with TB symptoms, not restricted to PLHIV. Our model projects that 2,700,000 (95% credible interval [CrI] 2,000,000–3,600,000) and 420,000 (95% CrI 350,000–520,000) cumulative TB incident cases and deaths, respectively, would occur between 2020 and 2035 if the status quo is maintained. Relative to this comparator, current and future LAM tests would respectively avert 54 (95% CrI 33–86) and 90 (95% CrI 55–145) TB deaths amongst inpatients between 2020 and 2035, i.e., reductions of 5% (95% CrI 4%–6%) and 9% (95% CrI 7%–11%) in inpatient TB mortality. This impact in absolute deaths averted doubles if testing is expanded to include outpatients, yet remains <1% of count
Cilloni L, Arinaminpathy N, Stagg H, et al., 2020, Trade-offs between cost and accuracy in active case-finding for tuberculosis: a dynamic modelling analysis, PLoS Medicine, Vol: 17, Pages: 1-20, ISSN: 1549-1277
BackgroundActive case-finding (ACF) may be valuable in tuberculosis (TB) control, but questions remain about its optimum implementation in different settings. For example, smear microscopy misses up to half of TB cases, yet is cheap, and detects the most infectious TB cases. What, then, is the incremental value of using more sensitive and specific, yet more costly, tests such as Xpert MTB/RIF, in ACF in a high burden setting?Methods and FindingsWe constructed a dynamic transmission model of TB, calibrated to be consistent with an urban slum population in India. We applied this model to compare the potential cost and impact of two hypothetical approaches, following initial symptom screening: (i) ‘moderate accuracy’ testing employing a microscopy-like test (that is, lower cost but also lower accuracy) for bacteriological confirmation and (ii) ‘high accuracy’ testing employing an Xpert-like test (higher-cost but also higher accuracy, while also detecting rifampicin resistance).Results suggest that ACF using a moderate-accuracy test could in fact cost more overall than using a high-accuracy test. Under an illustrative budget of USD 20 million in a slum population of 2 million, high-accuracy testing would avert 1·14 (95% Bayesian credible intervals 0·75 – 1·99, with p = 0.28) cases relative to each case averted by moderate-accuracy testing. Test specificity is a key driver: high-accuracy testing would be significantly more impactful at the 5% significance level, as long as the high-accuracy test has specificity at least 3 percentage points greater than the moderate-accuracy test. Additional factors promoting the impact of a high-accuracy are that: its ability to detect rifampicin resistance can lead to long-term cost savings in second-line treatment; and its higher sensitivity contributes to the overall cases averted by ACF.Amongst limitations of this study, our cost model has a narrow focus on the commodity costs of tes
Cilloni L, Fu H, Vesga JF, et al., 2020, The potential impact of the COVID-19 pandemic on the tuberculosis epidemic a modelling analysis, EClinicalMedicine, Vol: 28, ISSN: 2589-5370
Background: Routine services for tuberculosis (TB) are being disrupted by stringent lockdowns against the novel SARS-CoV-2 virus. We sought to estimate the potential long-term epidemiological impact of such disruptions on TB burden in high-burden countries, and how this negative impact could be mitigated. Methods: We adapted mathematical models of TB transmission in three high-burden countries (India, Kenya and Ukraine) to incorporate lockdown-associated disruptions in the TB care cascade. The anticipated level of disruption reflected consensus from a rapid expert consultation. We modelled the impact of these disruptions on TB incidence and mortality over the next five years, and also considered potential interventions to curtail this impact. Findings: Even temporary disruptions can cause long-term increases in TB incidence and mortality. If lockdown-related disruptions cause a temporary 50% reduction in TB transmission, we estimated that a 3-month suspension of TB services, followed by 10 months to restore to normal, would cause, over the next 5 years, an additional 1⋅19 million TB cases (Crl 1⋅06-1⋅33) and 361,000 TB deaths (CrI 333-394 thousand) in India, 24,700 (16,100-44,700) TB cases and 12,500 deaths (8.8-17.8 thousand) in Kenya, and 4,350 (826-6,540) cases and 1,340 deaths (815-1,980) in Ukraine. The principal driver of these adverse impacts is the accumulation of undetected TB during a lockdown. We demonstrate how long term increases in TB burden could be averted in the short term through supplementary "catch-up" TB case detection and treatment, once restrictions are eased. Interpretation: Lockdown-related disruptions can cause long-lasting increases in TB burden, but these negative effects can be mitigated with rapid restoration of TB services, and targeted interventions that are implemented as soon as restrictions are lifted. Funding: USAID and Stop TB Partnership.
Reid MJA, Silva S, Arinaminpathy N, et al., 2020, Building a tuberculosis-free world while responding to the COVID-19 pandemic, LANCET, Vol: 396, Pages: 1312-1313, ISSN: 0140-6736
Arinaminpathy N, Das J, McCormick TH, et al., 2020, Quantifying heterogeneity in SARS-CoV-2 transmission during the lockdown in India.
The novel SARS-CoV-2 virus shows marked heterogeneity in its transmission. Here, we used data collected from contact tracing during the lockdown in Punjab, a major state in India, to quantify this heterogeneity, and to examine implications for transmission dynamics. We found evidence of heterogeneity acting at multiple levels: in the number of potentially infectious contacts per index case, and in the per-contact risk of infection. Incorporating these findings in simple mathematical models of disease transmission reveals that these heterogeneities act in combination to strongly influence transmission dynamics. Standard approaches, such as representing heterogeneity through secondary case distributions, could be biased by neglecting these underlying interactions between heterogeneities. We discuss implications for policy, and for more efficient contact tracing in resource-constrained settings such as India. Our results highlight how contact tracing, an important public health measure, can also provide important insights into epidemic spread and control.
Hogan A, Jewell B, Sherrard-Smith E, et al., 2020, Potential impact of the COVID-19 pandemic on HIV, TB and malaria in low- and middle-income countries: a modelling study, The Lancet Global Health, Vol: 8, Pages: e1132-e1141, ISSN: 2214-109X
Background: COVID-19 has the potential to cause substantial disruptions to health services, including by cases overburdening the health system or response measures limiting usual programmatic activities. We aimed to quantify the extent to which disruptions in services for human immunodeficiency virus (HIV), tuberculosis (TB) and malaria in low- and middle-income countries with high burdens of those disease could lead to additional loss of life. Methods: We constructed plausible scenarios for the disruptions that could be incurred during the COVID-19 pandemic and used established transmission models for each disease to estimate the additional impact on health that could be caused in selected settings.Findings: In high burden settings, HIV-, TB- and malaria-related deaths over five years may increase by up to 10%, 20% and 36%, respectively, compared to if there were no COVID-19 pandemic. We estimate the greatest impact on HIV to be from interruption to antiretroviral therapy, which may occur during a period of high health system demand. For TB, we estimate the greatest impact is from reductions in timely diagnosis and treatment of new cases, which may result from any prolonged period of COVID-19 suppression interventions. We estimate that the greatest impact on malaria burden could come from interruption of planned net campaigns. These disruptions could lead to loss of life-years over five years that is of the same order of magnitude as the direct impact from COVID-19 in places with a high burden of malaria and large HIV/TB epidemics.Interpretation: Maintaining the most critical prevention activities and healthcare services for HIV, TB and malaria could significantly reduce the overall impact of the COVID-19 pandemic.Funding: Bill & Melinda Gates Foundation, The Wellcome Trust, DFID, MRC
Mandal S, Bhatia V, Sharma M, et al., 2020, The potential impact of preventive therapy against tuberculosis in the WHO South-East Asian Region: a modelling approach, BMC Medicine, Vol: 18, ISSN: 1741-7015
BackgroundThe prevention of tuberculosis (TB) is key for accelerating current, slow declines in TBburden. The 2018 World Health Organization (WHO) guidelines on eligibility forpreventive therapy to treat latent TB infection (LTBI) include: people living with humanimmunodeficiency virus (PLHIV), household contacts of TB patients including children,and those with clinical conditions including silicosis, dialysis, transplantation etc. andother country-specific groups. We aimed to estimate the potential impact of fullimplementation of these guidelines in the WHO South-East Asian (SEA) Region, whichbears the largest burden of TB and LTBI amongst the WHO Regions.MethodsWe developed mathematical models of TB transmission dynamics, calibratedindividually to each of the 11 countries in the Region. We modelled preventive therapyin the absence of other TB interventions. As an alternative comparator, reflectingongoing developments in TB control in the region, we also simulated improvements inthe treatment cascade for active TB, including private sector engagement andintensified case-finding. Relative to both scenarios, for each country in the region weprojected TB cases and deaths averted between 2020 and 2030, by full uptake ofpreventive therapy, defined as comprehensive coverage amongst eligible populationsas per WHO guidelines, and assuming outcomes consistent with clinical trials. We alsoperformed sensitivity analysis to illustrate impact under less-than-optimal conditions.ResultsAt the regional level, full uptake of preventive therapy amongst identified risk groupswould reduce annual incidence rates in 2030 by 8.30% (95% CrI 6.48 – 10.83) relativeto 2015, in the absence of any additional interventions. If implemented against abackdrop of improved TB treatment cascades, preventive therapy would achieve anincremental 6.93 percentage points (95% CrI 5.81 – 8.51) of reduction in annualincidence rates, compared to 2015. At the regional level, the numbers of individu
Cilloni L, Fu H, Vesga JF, et al., 2020, The potential impact of the COVID-19 pandemic on the tuberculosis epidemic: a modelling analysis, Publisher: SSRN
Background: Routine services for tuberculosis (TB) are being disrupted by stringent lockdowns against the novel SARS-CoV-2 virus. We sought to estimate the potential long-term epidemiological impact of such disruptions on TB burden in high-burden countries, and how this negative impact could be mitigated. Methods: We adapted mathematical models of TB transmission in three high-burden countries (India, Kenya and Ukraine) to incorporate lockdown-associated disruptions in the TB care cascade. The anticipated level of disruption reflected consensus from a rapid expert consultation. We modelled the impact of these disruptions on TB incidence and mortality over the next five years, and also considered potential interventions to curtail this impact. Results: Even temporary disruptions can cause long-term increases in TB incidence and mortality. We estimated that a 3-month lockdown, followed by 10 months to restore normal TB services, would cause, over the next 5 years, an additional 1.65 million TB cases (Crl 1.49– 1.85) and 438,000 TB deaths (CrI 403 – 483 thousand) in India, 41,400 (28,900–62,200) TB cases and 14,800 deaths (10.5 – 19.2 thousand) in Kenya, and 7,960 (6,250 – 9,880) cases and 2,050 deaths (1,610 - 2,360) in Ukraine. However, any such negative impacts could be averted through supplementary “catch-up” TB case detection and treatment, once restrictions are eased. Interpretation: Lockdown-related disruptions can cause long-lasting increases in TB burden, but these negative effects can be mitigated with targeted interventions implemented rapidly once lockdowns are lifted.Funding Statement: USAID and Stop TB Partnership.Declaration of Interests: The authors declare no conflict of interest.
Wagner CE, Hooshyar M, Baker RE, et al., 2020, Climatological, virological and sociological drivers of current and projected dengue fever outbreak dynamics in Sri Lanka, JOURNAL OF THE ROYAL SOCIETY INTERFACE, Vol: 17, ISSN: 1742-5689
Saad-Roy CM, Arinaminpathy N, Wingreen NS, et al., 2020, Implications of localized charge for human influenza A H1N1 hemagglutinin evolution: Insights from deep mutational scans, PLOS COMPUTATIONAL BIOLOGY, Vol: 16, ISSN: 1553-734X
Deo S, Singh S, Jha N, et al., 2020, Predicting the impact of patient and private provider behavior on diagnostic delay for pulmonary tuberculosis patients in India: A simulation modeling study, PLOS MEDICINE, Vol: 17, ISSN: 1549-1277
Arinaminpathy N, Chin DP, Sachdeva KS, et al., 2020, Modelling the potential impact of adherence technologies on tuberculosis in India, INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE, Vol: 24, Pages: 526-533, ISSN: 1027-3719
Lewnard JA, Lo NC, Arinaminpathy N, et al., 2020, Childhood vaccines and antibiotic use in low- and middle-income countries, NATURE, Vol: 581, Pages: 94-+, ISSN: 0028-0836
Arinaminpathy N, Gomez GB, Sachdeva KS, et al., 2020, The potential deployment of a pan-tuberculosis drug regimen in India: A modelling analysis, PLOS ONE, Vol: 15, ISSN: 1932-6203
Arinaminpathy N, Riley S, Barclay W, et al., 2020, Population implications of the deployment of novel universal vaccines against epidemic and pandemic influenza, Journal of the Royal Society Interface, ISSN: 1742-5662
Fu H, Lin H-H, Hallett TB, et al., 2020, Explaining age disparities in tuberculosis burden in Taiwan: a modelling study, BMC Infectious Diseases, Vol: 20, ISSN: 1471-2334
BackgroundTuberculosis (TB) burden shows wide disparities across ages in Taiwan. In 2016, the age-specific notification rate in those older than 65 years old was about 100 times as much as in those younger than 15 years old (185.0 vs 1.6 per 100,000 population). Similar patterns are observed in other intermediate TB burden settings. However, driving mechanisms for such age disparities are not clear and may have importance for TB control efforts.MethodsWe hypothesised three mechanisms for the age disparity in TB burden: (i) older age groups bear a higher risk of TB progression due to immune senescence, (ii) elderly cases acquired TB infection during a past period of high transmission, which has since rapidly declined and thus contributes to little recent infections, and (iii) assortative mixing by age allows elders to maintain a higher risk of TB infection, while limiting spillover transmission to younger age groups. We developed a series of dynamic compartmental models to incorporate these mechanisms, individually and in combination. The models were calibrated to the TB notification rates in Taiwan over 1997–2016 and evaluated by goodness-of-fit to the age disparities and the temporal trend in the TB burden, as well as the deviance information criterion (DIC). According to the model performance, we compared contributions of the hypothesised mechanisms.ResultsThe ‘full’ model including all the three hypothesised mechanisms best captured the age disparities and temporal trend of the TB notification rates. However, dropping individual mechanisms from the full model in turn, we found that excluding the mechanism of assortative mixing yielded the least change in goodness-of-fit. In terms of their influence on the TB dynamics, the major contribution of the ‘immune senescence’ and ‘assortative mixing’ mechanisms was to create disparate burden among age groups, while the ‘declining transmission’ mechanism s
Bhatia V, Srivastava R, Reddy KS, et al., 2020, Ending TB in Southeast Asia: current resources are not enough, BMJ GLOBAL HEALTH, Vol: 5, ISSN: 2059-7908
Mandal S, Bhatnagar T, Arinaminpathy N, et al., 2020, Prudent public health intervention strategies to control the coronavirus disease 2019 transmission in India: A mathematical model-based approach, INDIAN JOURNAL OF MEDICAL RESEARCH, Vol: 151, Pages: 190-199, ISSN: 0971-5916
Arinaminpathy N, Batra D, Maheshwari N, et al., 2019, Tuberculosis treatment in the private healthcare sector in India: An analysis of recent trends and volumes using drug sales data, BMC Infectious Diseases, Vol: 19, ISSN: 1471-2334
BackgroundThere is a pressing need for systematic approaches for monitoring how much TB treatment is ongoing in the private sector in India: both to cast light on the true scale of the problem, and to help monitor the progress of interventions currently being planned to address this problem.MethodsWe used commercially available data on the sales of rifampicin-containing drugs in the private sector, adjusted for data coverage and indication of use. We examined temporal, statewise trends in volumes (patient-months) of TB treatment from 2013 to 2016. We additionally analysed the proportion of drugs that were sold in combination packaging (designed to simplify TB treatment), or as loose pills.ResultsDrug sales suggest a steady trend of TB treatment dispensed by the private sector, from 18.4 million patient-months (95% CI 17.3–20.5) in 2013 to 16.8 patient-months (95% CI 15.5–19.0) in 2016. Overall, seven of 29 states in India accounted for more than 70% of national-level TB treatment volumes, including Uttar Pradesh, Maharashtra and Bihar. The overwhelming majority of TB treatment was dispensed not as loose pills, but in combination packaging with other TB drugs, accounting for over 96% of private sector TB treatment in 2017.ConclusionsOur findings suggest consistent levels of TB treatment in the private sector over the past 4 years, while highlighting specific states that should be prioritized for intervention. Drug sales data can be helpful for monitoring a system as large, disorganised and opaque as India’s private sector.
Nathavitharana RR, Yoon C, MacPherson P, et al., 2019, Guidance for Studies Evaluating the Accuracy of Tuberculosis Triage Tests, JOURNAL OF INFECTIOUS DISEASES, Vol: 220, Pages: S116-S125, ISSN: 0022-1899
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