Estimating the long-term effects of mass screening for latent and active tuberculosis in the Marshall Islands

Ragonnet, Romain, Williams, Bridget M., Largen, Angela, Nasa, Joaquin, Jack, Tom, Langinlur, Mailynn K., Ko, Eunyoung, Rahevar, Kalpeshsinh, Islam, Tauhid, Denholm, Justin T., Marais, Ben J., Marks, Guy B., McBryde, Emma S., and Trauer, James M. (2022) Estimating the long-term effects of mass screening for latent and active tuberculosis in the Marshall Islands. International Journal of Epidemiology, 51 (5). pp. 1433-1445.

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BACKGROUND: Ambitious population-based screening programmes for latent and active tuberculosis (TB) were implemented in the Republic of the Marshall Islands in 2017 and 2018.

METHODS: We used a transmission dynamic model of TB informed by local data to capture the Marshall Islands epidemic's historical dynamics. We then used the model to project the future epidemic trajectory following the active screening interventions, as well as considering a counterfactual scenario with no intervention. We also simulated future scenarios including periodic interventions similar to those previously implemented, to assess their ability to reach the End TB Strategy targets and TB pre-elimination in the Marshall Islands.

RESULTS: The screening activities conducted in 2017 and 2018 were estimated to have reduced TB incidence and mortality by around one-third in 2020, and are predicted to achieve the End TB Strategy milestone of 50% incidence reduction by 2025 compared with 2015. Screening interventions had a considerably greater impact when latent TB screening and treatment were included, compared with active case finding alone. Such combined programmes implemented at the national level could achieve TB pre-elimination around 2040 if repeated every 2 years.

CONCLUSIONS: Our model suggests that it would be possible to achieve TB pre-elimination by 2040 in the Marshall Islands through frequent repetition of the same interventions as those already implemented in the country. It also highlights the importance of including latent infection testing in active screening activities.

Item ID: 77620
Item Type: Article (Research - C1)
ISSN: 1464-3685
Keywords: active case-finding, latent tuberculosis infection, mass screening, Mycobacterium tuberculosis infection, post-exposure prevention
Copyright Information: © The Author(s) 2022. Published by Oxford University Press on behalf of the International Epidemiological Association. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Funders: National Health and Medical Research Council of Australia (NHMRC)
Projects and Grants: NHMRC APP1144570, NHMRC APP1142638
Date Deposited: 09 Mar 2023 03:37
FoR Codes: 42 HEALTH SCIENCES > 4202 Epidemiology > 420207 Major global burdens of disease @ 100%
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