title: Impact of enhanced tuberculosis diagnosis in South Africa: a mathematical model of expanded culture and drug susceptibility testing.
abstract: South Africa has high rates of tuberculosis (TB), including multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains. Expanding access to culture and drug susceptibility testing (DST) for TB diagnosis may help control this epidemic, but the potential impact of existing and novel TB diagnostics is uncertain. By fitting to World Health Organization epidemiological estimates, we developed a compartmental difference-equation model of the TB/HIV epidemic among South African adults. Performing culture and DST in 37% of new cases and 85% of previously treated cases was projected to save 47,955 lives (17.2% reduction in TB mortality, 95% simulation interval (S.I.) 8.9-24.4%), avert 7,721 MDR-TB cases (14.1% reduction, 95% S.I. 5.3-23.8%), and prevent 46.6% of MDR-TB deaths (95% S.I. 32.6-56.0%) in South Africa over 10 years. Used alone, expanded culture and DST did not reduce XDR-TB incidence, but they enhanced the impact of transmission-reduction strategies, such as respiratory isolation. In South Africa, expanding TB culture and DST could substantially reduce TB, and particularly MDR-TB, mortality. Control of XDR-TB will require additional interventions, the impact of which may be enhanced by improved TB diagnosis.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Suite W6508, Baltimore, MD 21205, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Dowdy
authors.forename: Richard E
authors.initials: RE
authors.lastname: Chaisson
authors.forename: Gary
authors.initials: G
authors.lastname: Maartens
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Corbett
authors.forename: Susan E
authors.initials: SE
authors.lastname: Dorman
mesh_terms: D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis* / Q000401:mortality* / Q000635:transmission; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D013997:Time Factors; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis* / Q000401:mortality* / Q000635:transmission; D014944:World Health Organization