Geospatial clustering and modelling provide policy guidance to distribute funding for active TB case finding in Ethiopia

Shaweno, Debebe, Trauer, James M., Doan, Tan N., Denholm, Justin T., and McBryde, Emma S. (2021) Geospatial clustering and modelling provide policy guidance to distribute funding for active TB case finding in Ethiopia. Epidemics, 36. 100470.

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Abstract

Tuberculosis (TB) exhibits considerable spatial heterogeneity, occurring in clusters that may act as hubs of community transmission. We evaluated the impact of an intervention targeting spatial TB hotspots in a rural region of Ethiopia. To evaluate the impact of targeted active case finding (ACF), we used a spatially structured mathematical model that has previously been described. From model equilibrium, we simulated the impact of a hotspot-targeted strategy (HTS) on TB incidence ten years from intervention commencement and the associated cost-effectiveness. HTS was also compared with an untargeted strategy (UTS). We used logistic cost-coverage analysis to estimate cost-effectiveness of interventions. At a community screening coverage level of 95 % in a hotspot region, which corresponds to screening 20 % of the total population, HTS would reduce overall TB incidence by 52 % compared with baseline. For UTS to achieve an equivalent effect, it would be necessary to screen more than 80 % of the total population. Compared to the existing passive case detection strategy, the HTS at a CDR of 75 percent in hotspot regions is expected to avert 1,023 new TB cases over ten years saving USD 170 per averted case. Similarly, at the same CDR, the UTS will detect 1316 cases over the same period saving USD 3 per averted TB case. The incremental-cost effectiveness-ratio (ICER) of UTS compared with HTS is USD 582 per averted case corresponding to 293 more TB cases averted at an additional cost of USD 170,700. Where regional TB program spending was capped at current levels, maximum gains in incidence reduction were seen when the regional budget was shared between hotspots and non-hotspot regions in the ratio of 40% : 60%. Our analysis suggests that a spatially targeted strategy is efficient and cost-saving, with the potential for significant reduction in overall TB burden.

Item ID: 70170
Item Type: Article (Research - C1)
ISSN: 1878-0067
Keywords: Active TB case finding, Cost-effectiveness analysis, Geospatial clustering, Mathematical modelling, Tuberculosis
Copyright Information: © 2021 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license
Funders: National Health and Medical Research Council of Australia (NHMRC)
Projects and Grants: NHMRC APP1142638
Date Deposited: 23 Mar 2022 02:42
FoR Codes: 49 MATHEMATICAL SCIENCES > 4901 Applied mathematics > 490102 Biological mathematics @ 30%
42 HEALTH SCIENCES > 4202 Epidemiology > 420205 Epidemiological modelling @ 70%
SEO Codes: 20 HEALTH > 2004 Public health (excl. specific population health) > 200404 Disease distribution and transmission (incl. surveillance and response) @ 80%
20 HEALTH > 2002 Evaluation of health and support services > 200205 Health policy evaluation @ 20%
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