Modelling the potential impact of adherence technologies on tuberculosis in India
METHOD: We developed a mathematical model of TB transmission dynamics in India, capturing the independent effects of missed doses and treatment default on post-treatment recurrence. We simulated the impact of interventions to address both missed doses and treatment default in the public and private healthcare sector.
RESULTS: Adherence interventions, if deployed optimally in the public sector alone, would reduce cumulative TB incidence by 7.3% (95% credible intervals [CrI] 4.7–11) between 2020 and 2030, and by 16% (95% CrI 11–23) if also deployed in the private sector. This impact is roughly proportional to the effectiveness of the interventions. Reducing missed doses reduced incidence by 12% (95% CrI 7.0–18), while reducing treatment default reduced incidence by 7.9% (95% CrI 3.2–13).
CONCLUSION: Minimising missed doses is at least as important as promoting treatment completion. Our results suggest that emerging technologies to improve treatment adherence could have a substantial impact on TB incidence and mortality in India.
Document Type: Research Article
Affiliations: 1: Imperial College London, UK 2: Bill and Melinda Gates Foundation, Seattle, WA, USA 3: Central TB Division, New Delhi 4: World Health Organization, India Country Office, New Delhi, India 5: Stop TB Partnership, Geneva, Switzerland 6: Independent Consultant, Seattle, WA, USA
Publication date: May 1, 2020
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