A modelling framework to support the selection and implementation of new tuberculosis diagnostic tools [State of the art series. Operational research. Number 8 in the series]
Efforts to stimulate technological innovation in the diagnosis of tuberculosis (TB) have resulted in the recent introduction of several novel diagnostic tools. As these products come to market, policy makers must make difficult decisions about which of the available tools to implement.
This choice should depend not only on the test characteristics (e.g., sensitivity and specificity) of the tools, but also on how they will be used within the existing health care infrastructure. Accordingly, policy makers choosing between diagnostic strategies must decide: 1) What is the best
combination of tools to select? 2)Who should be tested with the new tools? and 3)Will these tools complement or replace existing diagnostics? The best choice of diagnostic strategy will likely vary between settings with different epidemiology (e.g., levels of TB incidence,
human immunodeficiency virus co-infection and drug-resistant TB) and structural and resource constraints (e.g., existing diagnostic pathways, human resources and laboratory capacity). We propose a joint modelling framework that includes a tuberculosis (TB) transmission component (a dynamic
epidemiological model) and a health system component (an operational systems model) to support diagnostic strategy decisions. This modelling approach captures the complex feedback loops in this system: new diagnostic strategies alter the demands on and performance of health systems that impact
TB transmission dynamics which, in turn, result in further changes to demands on the health system. We demonstrate the use of a simplified model to support the rational choice of a diagnostic strategy based on health systems requirements, patient outcomes and population-level TB impact.
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Document Type: Review Article
Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan; International Union Against Tuberculosis and Lung Disease, Paris, France; and Department of Community Health, Mennonite Christian Hospital, Hualien,
Liverpool School of Tropical Medicine, Liverpool, UK
Health Technical Support Services (Diagnostics), Ministry of Health, Lilongwe, Malawi
National Tuberculosis and Leprosy Control Program, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA; and Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
Publication date: August 1, 2011
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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.
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