The potential deployment of a pan-tuberculosis drug regimen in India: A modelling analysis.

Autor: Arinaminpathy N; MRC Centre for Global Infectious Disease Analysis, Faculty of Medicine, Imperial College London, United Kingdom., Gomez GB; Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom., Sachdeva KS; Central TB Division, Government of India, New Delhi, India., Rao R; Central TB Division, Government of India, New Delhi, India., Parmar M; India Country Office, World Health Organization, New Delhi, India., Nair SA; Stop TB Partnership, Geneva, Switzerland., Rade K; India Country Office, World Health Organization, New Delhi, India., Kumta S; Bill and Melinda Gates Foundation, India Country Office, New Delhi, India., Hermann D; Bill and Melinda Gates Foundation, Seattle, WA, United States of America., Hanson C; Bill and Melinda Gates Foundation, Seattle, WA, United States of America., Chin DP; Bill and Melinda Gates Foundation, Seattle, WA, United States of America., Dewan P; Global Good, Intellectual Ventures, Seattle, WA, United States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2020 Mar 27; Vol. 15 (3), pp. e0230808. Date of Electronic Publication: 2020 Mar 27 (Print Publication: 2020).
DOI: 10.1371/journal.pone.0230808
Abstrakt: There is increasing interest in future, highly-potent 'pan-TB' regimens against tuberculosis (TB), that may be equally effective in both drug-susceptible and rifampicin-resistant (RR) forms of TB. Taking the example of India, the country with the world's largest burden of TB, we show that adoption of these regimens could be: (i) epidemiologically impactful, and (ii) cost-saving to the national TB programme, even if the regimen itself is more costly than current TB treatment. Mathematical modelling suggests that deployment of a pan-TB regimen in 2022 would reduce the annual incidence of TB in 2030 by 23.9% [95% Bayesian credible intervals [CrI] 17.6-30.8%] if used to treat all TB cases, and by 2.30% [95% CrI 1.57-3.48%] if used to treat only RR-TB. Notably, with a regimen costing less than USD 359 (95% CrI 287-441), treating all diagnosed TB cases with the pan-TB regimen yielded greater cost-savings than treating just those diagnosed with RR-TB. One limitation of our approach is that it does not capture the risk of resistance to the new regimen. We discuss ways in which this risk could be mitigated using modern adherence support mechanisms, as well as drug sensitivity testing at the point of TB diagnosis, to prevent new resistant forms from becoming established. A combination of such approaches would be important for maximising the useful lifetime of any future regimen.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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