title: High coverage with HAART is required to substantially reduce the number of deaths from tuberculosis: system dynamics simulation.
abstract: We used a system dynamics simulation model of the transmission dynamics of drug-sensitive tuberculosis (DSTB), multidrug-resistant tuberculosis (MDRTB) and HIV to estimate the impact of coverage with highly active antiretroviral therapy (HAART) and different cure rates for MDRTB in settings of explosive HIV epidemics and high MDRTB levels. Population coverage levels at 0%, 25%, 50%, 75% and 100% for HAART, and 5% and 80% of MDRTB treatment cure rates were simulated over a 10-year period and cumulative deaths from tuberculosis and HIV-associated tuberculosis were estimated for populations with latent tuberculosis, DSTB, MDRTB, HIV and HIV-associated tuberculosis. Depending on levels of HAART population coverage, increasing MDRTB cure rates from 5% to 80% reduces cumulative tuberculosis deaths by 1% and 13%. High population coverage with HAART (75% or higher), allied with high MDRTB cure rates, reduces cumulative deaths by 60%, with limited impact below this level. High coverage with HAART is required to substantially reduce the number of deaths from tuberculosis.
authors.affiliation: Centre for Health Management, Tanaka Business School, Imperial College London, South Kensington Campus, London, UK. r.atun@imperial.ac.uk
authors.forename: Rifat A
authors.initials: RA
authors.lastname: Atun
authors.forename: Reda M
authors.initials: RM
authors.lastname: Lebcir
authors.forename: Francis
authors.initials: F
authors.lastname: Drobniewski
authors.forename: Martin
authors.initials: M
authors.lastname: McKee
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Coker
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000517:prevention & control*; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008954:Models, Biological; D012426:Russia / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology / Q000517:prevention & control*