ArticleAmerican journal of epidemiology2019
Estimating the Impact of Tuberculosis Case Detection in Constrained Health Systems: An Example of Case-Finding in South Africa.
Article in American journal of epidemiology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.
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Who cites it
11 citing papers in PubMed, 2 syntheses or guidelines pooled it, 20 citations in OpenAlex.
- Building resource constraints and feasibility considerations in mathematical models for infectious disease: A systematic literature review.Epidemics · 2021Pooled it
- Pooled it
- Towards ending tuberculosis in South Africa: an uncertainty analysis of the programmes and factors most critical to future declines.Global health action · 2026Article
- Impact of Community-Wide Tuberculosis Active Case Finding and Human Immunodeficiency Virus Testing on Tuberculosis Trends in Malawi.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Article
- Cost to perform door-to-door universal sputum screening for TB in a high-burden community.The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2023Article
- Operational research: A multidisciplinary approach for the management of infectious disease in a global context.European journal of operational research · 2021Article
- Costs and cost-effectiveness of a comprehensive tuberculosis case finding strategy in Zambia.PloS one · 2021Article
- The potential impact of urine-LAM diagnostics on tuberculosis incidence and mortality: A modelling analysis.PLoS medicine · 2020Article
- The predicted impact of tuberculosis preventive therapy: the importance of disease progression assumptions.BMC infectious diseases · 2020Article
- Informing Balanced Investment in Services and Health Systems: A Case Study of Priority Setting for Tuberculosis Interventions in South Africa.Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · 2020Article
- Integrating economic and health evidence to inform Covid-19 policy in low- and middle- income countries.Wellcome open research · 2020Article
Corrections and comments
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Authors and funding
8 authors at 2 institutions in 2 countries.
Funding
Abstract
Mathematical models are increasingly being used to compare strategies for tuberculosis (TB) control and inform policy decisions. Models often do not consider financial and other constraints on implementation and may overestimate the impact that can be achieved. We developed a pragmatic approach for incorporating resource constraints into mathematical models of TB. Using a TB transmission model calibrated for South Africa, we estimated the epidemiologic impact and resource requirements (financial, human resource (HR), and diagnostic) of 9 case-finding interventions. We compared the model-estimated resources with scenarios of future resource availability and estimated the impact of interventions under these constraints. Without constraints, symptom screening in public health clinics and among persons receiving care for human immunodeficiency virus infection was predicted to lead to larger reductions in TB incidence (9.5% (2.5th-97.5th percentile range (PR), 8.6-12.2) and 14.5% (2.5th-97.5th PR, 12.2-16.3), respectively) than improved adherence to diagnostic guidelines (2.7%; 2.5th-97.5th PR, 1.6-4.1). However, symptom screening required large increases in resources, exceeding future HR capacity. Even under our most optimistic HR scenario, the reduction in TB incidence from clinic symptom screening was 0.2%-0.9%-less than that of improved adherence to diagnostic guidelines. Ignoring resource constraints may result in incorrect conclusions about an intervention's impact and may lead to suboptimal policy decisions. Models used for decision-making should consider resource constraints.
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