在艾滋病毒流行的环境中通过社区护理预防结核病:模型分析。

IF 4.6 1区 医学 Q2 IMMUNOLOGY Journal of the International AIDS Society Pub Date : 2024-06-11 DOI:10.1002/jia2.26272
Jennifer M. Ross, Chelsea Greene, Cara J. Broshkevitch, David W. Dowdy, Alastair van Heerden, Jesse Heitner, Darcy W. Rao, D. Allen Roberts, Adrienne E. Shapiro, Zelda B. Zabinsky, Ruanne V. Barnabas
{"title":"在艾滋病毒流行的环境中通过社区护理预防结核病:模型分析。","authors":"Jennifer M. Ross,&nbsp;Chelsea Greene,&nbsp;Cara J. Broshkevitch,&nbsp;David W. Dowdy,&nbsp;Alastair van Heerden,&nbsp;Jesse Heitner,&nbsp;Darcy W. Rao,&nbsp;D. Allen Roberts,&nbsp;Adrienne E. Shapiro,&nbsp;Zelda B. Zabinsky,&nbsp;Ruanne V. Barnabas","doi":"10.1002/jia2.26272","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>Antiretroviral therapy (ART) and tuberculosis preventive treatment (TPT) both prevent tuberculosis (TB) disease and deaths among people living with HIV. Differentiated care models, including community-based care, can increase the uptake of ART and TPT to prevent TB in settings with a high burden of HIV-associated TB, particularly among men.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We developed a gender-stratified dynamic model of TB and HIV transmission and disease progression among 100,000 adults ages 15−59 in KwaZulu-Natal, South Africa. We drew model parameters from a community-based ART initiation and resupply trial in sub-Saharan Africa (Delivery Optimization for Antiretroviral Therapy, DO ART) and other scientific literature. We simulated the impacts of community-based ART and TPT care programmes during 2018−2027, assuming that community-based ART and TPT care were scaled up to similar levels as in the DO ART trial (i.e. ART coverage increasing from 49% to 82% among men and from 69% to 83% among women) and sustained for 10 years. We projected the number of TB cases, deaths and disability-adjusted life years (DALYs) averted relative to standard, clinic-based care. We calculated programme costs and incremental cost-effectiveness ratios from the provider perspective.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>If community-based ART care could be implemented with similar effectiveness to the DO ART trial, increased ART coverage could reduce TB incidence by 27.0% (range 21.3%−34.1%) and TB mortality by 34.6% (range 24.8%–42.2%) after 10 years. Increasing both ART and TPT uptake through community-based ART with TPT care could reduce TB incidence by 29.7% (range 23.9%−36.0%) and TB mortality by 36.0% (range 26.9%−43.8%). Community-based ART with TPT care reduced gender disparities in TB mortality rates, with a projected 54 more deaths annually among men than women (range 11–103) after 10 years of community-based care versus 109 (range 41–182) in standard care. Over 10 years, the mean cost per DALY averted by community-based ART with TPT care was $846 USD (range $709–$1012).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>By substantially increasing coverage of ART and TPT, community-based care for people living with HIV could reduce TB incidence and mortality in settings with high burdens of HIV-associated TB and reduce TB gender disparities.</p>\n </section>\n </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":null,"pages":null},"PeriodicalIF":4.6000,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26272","citationCount":"0","resultStr":"{\"title\":\"Preventing tuberculosis with community-based care in an HIV-endemic setting: a modelling analysis\",\"authors\":\"Jennifer M. Ross,&nbsp;Chelsea Greene,&nbsp;Cara J. Broshkevitch,&nbsp;David W. Dowdy,&nbsp;Alastair van Heerden,&nbsp;Jesse Heitner,&nbsp;Darcy W. Rao,&nbsp;D. Allen Roberts,&nbsp;Adrienne E. Shapiro,&nbsp;Zelda B. Zabinsky,&nbsp;Ruanne V. Barnabas\",\"doi\":\"10.1002/jia2.26272\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Introduction</h3>\\n \\n <p>Antiretroviral therapy (ART) and tuberculosis preventive treatment (TPT) both prevent tuberculosis (TB) disease and deaths among people living with HIV. Differentiated care models, including community-based care, can increase the uptake of ART and TPT to prevent TB in settings with a high burden of HIV-associated TB, particularly among men.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>We developed a gender-stratified dynamic model of TB and HIV transmission and disease progression among 100,000 adults ages 15−59 in KwaZulu-Natal, South Africa. We drew model parameters from a community-based ART initiation and resupply trial in sub-Saharan Africa (Delivery Optimization for Antiretroviral Therapy, DO ART) and other scientific literature. We simulated the impacts of community-based ART and TPT care programmes during 2018−2027, assuming that community-based ART and TPT care were scaled up to similar levels as in the DO ART trial (i.e. ART coverage increasing from 49% to 82% among men and from 69% to 83% among women) and sustained for 10 years. We projected the number of TB cases, deaths and disability-adjusted life years (DALYs) averted relative to standard, clinic-based care. We calculated programme costs and incremental cost-effectiveness ratios from the provider perspective.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>If community-based ART care could be implemented with similar effectiveness to the DO ART trial, increased ART coverage could reduce TB incidence by 27.0% (range 21.3%−34.1%) and TB mortality by 34.6% (range 24.8%–42.2%) after 10 years. Increasing both ART and TPT uptake through community-based ART with TPT care could reduce TB incidence by 29.7% (range 23.9%−36.0%) and TB mortality by 36.0% (range 26.9%−43.8%). Community-based ART with TPT care reduced gender disparities in TB mortality rates, with a projected 54 more deaths annually among men than women (range 11–103) after 10 years of community-based care versus 109 (range 41–182) in standard care. Over 10 years, the mean cost per DALY averted by community-based ART with TPT care was $846 USD (range $709–$1012).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>By substantially increasing coverage of ART and TPT, community-based care for people living with HIV could reduce TB incidence and mortality in settings with high burdens of HIV-associated TB and reduce TB gender disparities.</p>\\n </section>\\n </div>\",\"PeriodicalId\":201,\"journal\":{\"name\":\"Journal of the International AIDS Society\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.6000,\"publicationDate\":\"2024-06-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26272\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the International AIDS Society\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/jia2.26272\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"IMMUNOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the International AIDS Society","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/jia2.26272","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
引用次数: 0

摘要

导言:抗逆转录病毒疗法(ART)和结核病预防治疗(TPT)都能预防结核病和艾滋病病毒感染者的死亡。包括社区护理在内的差异化护理模式可以提高抗逆转录病毒疗法和结核病预防治疗的使用率,从而在艾滋病相关结核病负担较重的环境中预防结核病,尤其是在男性中:我们在南非夸祖鲁-纳塔尔省 10 万名 15-59 岁的成年人中建立了一个结核病和 HIV 传播及疾病进展的性别分层动态模型。我们从撒哈拉以南非洲的一项基于社区的抗逆转录病毒疗法启动和再供给试验(抗逆转录病毒疗法的优化交付,DO ART)和其他科学文献中提取了模型参数。我们模拟了 2018-2027 年期间社区抗逆转录病毒疗法和 TPT 护理计划的影响,假设社区抗逆转录病毒疗法和 TPT 护理扩大到与 DO ART 试验类似的水平(即男性抗逆转录病毒疗法覆盖率从 49% 提高到 82%,女性从 69% 提高到 83%),并持续 10 年。我们预测了相对于标准诊所治疗而言所避免的结核病例数、死亡人数和残疾调整生命年数。我们从提供者的角度计算了项目成本和增量成本效益比:如果社区抗逆转录病毒疗法的实施效果与 DO 抗逆转录病毒疗法试验相似,那么在 10 年后,抗逆转录病毒疗法覆盖率的提高可使结核病发病率降低 27.0%(范围为 21.3%-34.1%),结核病死亡率降低 34.6%(范围为 24.8%-42.2%)。通过基于社区的抗逆转录病毒疗法和 TPT 护理,提高抗逆转录病毒疗法和 TPT 的使用率,可使结核病发病率降低 29.7%(范围为 23.9%-36.0%),结核病死亡率降低 36.0%(范围为 26.9%-43.8%)。基于社区的抗逆转录病毒疗法和 TPT 治疗减少了结核病死亡率的性别差异,预计在基于社区的治疗 10 年后,每年男性死亡人数比女性多 54 人(范围为 11-103 人),而标准治疗每年死亡人数为 109 人(范围为 41-182)。10 年间,社区抗逆转录病毒疗法和 TPT 治疗可避免的每 DALY 平均成本为 846 美元(范围在 709 美元至 1012 美元之间):结论:通过大幅提高抗逆转录病毒疗法和 TPT 的覆盖率,对艾滋病病毒感染者进行社区护理可降低艾滋病相关结核病高负担地区的结核病发病率和死亡率,并减少结核病的性别差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

摘要图片

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
Preventing tuberculosis with community-based care in an HIV-endemic setting: a modelling analysis

Introduction

Antiretroviral therapy (ART) and tuberculosis preventive treatment (TPT) both prevent tuberculosis (TB) disease and deaths among people living with HIV. Differentiated care models, including community-based care, can increase the uptake of ART and TPT to prevent TB in settings with a high burden of HIV-associated TB, particularly among men.

Methods

We developed a gender-stratified dynamic model of TB and HIV transmission and disease progression among 100,000 adults ages 15−59 in KwaZulu-Natal, South Africa. We drew model parameters from a community-based ART initiation and resupply trial in sub-Saharan Africa (Delivery Optimization for Antiretroviral Therapy, DO ART) and other scientific literature. We simulated the impacts of community-based ART and TPT care programmes during 2018−2027, assuming that community-based ART and TPT care were scaled up to similar levels as in the DO ART trial (i.e. ART coverage increasing from 49% to 82% among men and from 69% to 83% among women) and sustained for 10 years. We projected the number of TB cases, deaths and disability-adjusted life years (DALYs) averted relative to standard, clinic-based care. We calculated programme costs and incremental cost-effectiveness ratios from the provider perspective.

Results

If community-based ART care could be implemented with similar effectiveness to the DO ART trial, increased ART coverage could reduce TB incidence by 27.0% (range 21.3%−34.1%) and TB mortality by 34.6% (range 24.8%–42.2%) after 10 years. Increasing both ART and TPT uptake through community-based ART with TPT care could reduce TB incidence by 29.7% (range 23.9%−36.0%) and TB mortality by 36.0% (range 26.9%−43.8%). Community-based ART with TPT care reduced gender disparities in TB mortality rates, with a projected 54 more deaths annually among men than women (range 11–103) after 10 years of community-based care versus 109 (range 41–182) in standard care. Over 10 years, the mean cost per DALY averted by community-based ART with TPT care was $846 USD (range $709–$1012).

Conclusions

By substantially increasing coverage of ART and TPT, community-based care for people living with HIV could reduce TB incidence and mortality in settings with high burdens of HIV-associated TB and reduce TB gender disparities.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Journal of the International AIDS Society
Journal of the International AIDS Society IMMUNOLOGY-INFECTIOUS DISEASES
CiteScore
8.60
自引率
10.00%
发文量
186
审稿时长
>12 weeks
期刊介绍: The Journal of the International AIDS Society (JIAS) is a peer-reviewed and Open Access journal for the generation and dissemination of evidence from a wide range of disciplines: basic and biomedical sciences; behavioural sciences; epidemiology; clinical sciences; health economics and health policy; operations research and implementation sciences; and social sciences and humanities. Submission of HIV research carried out in low- and middle-income countries is strongly encouraged.
期刊最新文献
Excess mortality attributable to AIDS among people living with HIV in high-income countries: a systematic review and meta-analysis Pre-exposure prophylaxis implementation gaps among people vulnerable to HIV acquisition: a cross-sectional analysis in two communities in western Kenya, 2021–2023 Issue Information Power, data and social accountability: defining a community-led monitoring model for strengthened health service delivery Very high HIV prevalence and incidence among men who have sex with men and transgender women in Indonesia: a retrospective observational cohort study in Bali and Jakarta, 2017–2020
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1