Strategic investment in tuberculosis control in the Republic of Bulgaria

Doan, T.N., Varleva, T., Zamfirova, M., Tyufekchieva, M., Keshelava, A., Hristov, K., Yaneva, A., Gadzheva, B., Zhang, S., Irbe, S., Ragonnet, R., McBryde, E.S., and Trauer, J.M. (2019) Strategic investment in tuberculosis control in the Republic of Bulgaria. Epidemiology and Infection, 147. e304.

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As Bulgaria transitions away from Global Fund grant, robust estimates of the comparative impact of the various response strategies under consideration are needed to ensure sustained effectiveness of the tuberculosis (TB) programme. We tailored an established mathematical model for TB control to the epidemic in Bulgaria to project the likely outcomes of seven intervention scenarios. Under existing programmatic conditions projected forward, the country's targets for achieving TB elimination in the coming decades will not be achieved. No interventions under consideration were predicted to accelerate the baseline projected reduction in epidemiological indicators significantly. Discontinuation of the 'Open Doors' program and activities of non-governmental organisations would result in a marked exacerbation of the epidemic (increasing incidence in 2035 by 6-8% relative to baseline conditions projected forward). Changing to a short course regimen for multidrug-resistant TB (MDR-TB) would substantially decrease MDR-TB mortality (by 21.6% in 2035 relative to baseline conditions projected forward). Changing to ambulatory care for eligible patients would not affect TB burden but would be markedly cost-saving. In conclusion, Bulgaria faces important challenges in transitioning to a primarily domestically-financed TB programme. The country should consider maintaining currently effective programs and shifting towards ambulatory care to ensure program sustainability.

Item ID: 61675
Item Type: Article (Research - C1)
ISSN: 1469-4409
Keywords: End TB targets, mathematical modelling, transmission dynamics
Copyright Information: © The Author(s) 2019.
Funders: Global Fund to Fight AIDS, Tuberculosis and Malaria
Date Deposited: 06 May 2020 23:23
FoR Codes: 42 HEALTH SCIENCES > 4203 Health services and systems > 420310 Health surveillance @ 100%
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