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Open Access Is IPT more effective in high-burden settings? Modelling the effect of tuberculosis incidence on IPT impact

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SETTING: Isoniazid preventive therapy (IPT) is effective for preventing active tuberculosis (TB), although its mechanism of action is poorly understood and the optimal disease burden for IPT use has not been defined.

OBJECTIVE: To describe the relationship between TB incidence and IPT effectiveness.

METHODS: We constructed a model of TB transmission dynamics to investigate IPT effectiveness under various epidemiological settings. The model structure was intended to be highly adaptable to uncertainty in both input parameters and the mechanism of action of IPT. To determine the optimal setting for IPT use, we identified the lowest number needed to treat (NNT) with IPT to prevent one case of active TB.

RESULTS: We found that the NNT as a function of TB incidence shows a ‘U-shape', whereby IPT impact is greatest at an intermediate incidence and attenuated at both lower and higher incidence levels. This U-shape was observed over a broad range of parameter values; the optimal TB incidence was between 500 and 900 cases per 100 000 per year.

CONCLUSIONS: TB burden is a critical factor to consider when making decisions about communitywide implementation of IPT. We believe that the total disease burden should not preclude programmatic application of IPT.
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Keywords: latent tuberculous infection; optimal impact; preventive therapy

Document Type: Research Article

Affiliations: 1: Department of Medicine, Royal Melbourne Hospital/Western Hospital, University of Melbourne, Parkville, Centre for Population Health, Burnet Institute, Melbourne, Australia 2: Department of Medicine, Royal Melbourne Hospital/Western Hospital, University of Melbourne, Parkville, Australia; Centre for Population Health, Burnet Institute, Melbourne, Victorian Tuberculosis Program, Melbourne Health, Melbourne, Victoria, Australia 3: Department of Medicine, Royal Melbourne Hospital/Western Hospital, University of Melbourne, Parkville, Centre for Population Health, Burnet Institute, Melbourne, Australia; Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia 4: Department of Infectious Disease Epidemiology, TB Modelling Group, TB Centre, and Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK 5: Victorian Tuberculosis Program, Melbourne Health, Melbourne, Victoria, Australia; Department of Microbiology and Immunology, University of Melbourne, Melbourne, Australia; Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria, Australia 6: Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia, USA

Publication date: 2017-01-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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