Scenario analysis for programmatic tuberculosis control in Western Province, Papua New Guinea

Trauer, James M., Denholm, Justin, Waseem, Saba, Ragonnet, Romain, and McBryde, Emma (2016) Scenario analysis for programmatic tuberculosis control in Western Province, Papua New Guinea. American Journal of Epidemiology, 183 (12). pp. 1138-1148.

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Abstract

Tuberculosis (TB) and multidrug-resistant TB (MDR-TB) are major health problems in Western Province, Papua New Guinea. While comprehensive expansion of TB control programs is desirable, logistical challenges are considerable, and there is substantial uncertainty regarding the true disease burden. We parameterized our previously described mathematical model of Mycobacterium tuberculosis dynamics in Western Province, following an epidemiologic assessment. Five hypothetical scenarios representing alternative programmatic approaches during the period from 2013 to 2023 were developed with local staff. Bayesian uncertainty analyses were undertaken to explicitly acknowledge the uncertainty around key epidemiologic parameters, and an economic evaluation was performed. With continuation of existing programmatic strategies, overall TB incidence remained stable at 555 cases per 100,000 population per year (95% simulation interval (SI): 420, 807), but the proportion of incident cases attributable to MDR-TB increased from 16% to 35%. Comprehensive, provincewide strengthening of existing programs reduced incidence to 353 cases per 100,000 population per year (95% SI: 246, 558), with 46% being cases of MDR-TB, while incorporating programmatic management of MDR-TB into these programs reduced incidence to 233 cases per 100,000 population per year (95% SI: 198, 269) with 14% MDR-TB. Most economic costs were due to hospitalization during the intensive treatment phase. Broad scale-up of TB control activities in Western Province with incorporation of programmatic management of MDR-TB is vital if control is to be achieved. Community-based treatment approaches are important to reduce the associated economic costs.

Item ID: 44843
Item Type: Article (Research - C1)
ISSN: 1476-6256
Keywords: Bayesian probability; models, biological; Papua New Guinea; tuberculosis; tuberculosis, multidrug-resistant
Funders: Australian Agency for International Development (AusAID), National Health and Medical Research Council of Australia (NHMRC)
Date Deposited: 28 Jul 2016 02:26
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110309 Infectious Diseases @ 34%
11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111715 Pacific Peoples Health @ 33%
16 STUDIES IN HUMAN SOCIETY > 1605 Policy and Administration > 160508 Health Policy @ 33%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920109 Infectious Diseases @ 50%
92 HEALTH > 9203 Indigenous Health > 920309 Pacific Peoples Health - Health System Performance (incl. Effectiveness of Interventions) @ 50%
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