title: Mass treatment to eliminate tuberculosis from an island population.
abstract: METHODS
  The global target of tuberculosis (TB) elimination by 2050 requires new approaches. Active case finding plus mass prophylactic treatment has been disappointing. We consider mass full anti-tuberculosis treatment as an approach to TB elimination in Kiribati, a Pacific Island nation, with a persistent epidemic of high TB incidence.
  
  
  OBJECTIVE
  To construct a mathematical model to predict whether mass treatment with a full course of anti-tuberculosis drugs might eliminate TB from the defined population of the Republic of Kiribati.
  
  
  METHODS
  We constructed a seven-state compartmental model of the life cycle of Mycobacterium tuberculosis in which active TB disease arises from the progression of infection, reinfection, reactivation and relapse, while distinguishing infectious from non-infectious disease. We evaluated the effects of 5-yearly mass treatment using a range of parameter values to generate outcomes in uncertainty analysis.
  
  
  RESULTS
  Assuming population-wide treatment effectiveness for latent tuberculous infection and active TB of ⩾90%, annual TB incidence is expected to fall sharply at each 5-yearly round of treatment, approaching elimination in two decades. The model showed that the incidence rate is sensitive to the relapse rate after successful treatment of TB.
  
  
  CONCLUSIONS
  Mass treatment may help to eliminate TB, at least for discrete or geographically isolated populations.
authors.affiliation: <label>*</label>Centre for International Health, Department of Preventive and Social Medicine, Faculty of Medicine, University of Otago, Dunedin, New Zealand;
authors.forename: P C
authors.initials: PC
authors.lastname: Hill
authors.affiliation: <label><sup>†</sup></label>HIV/AIDS, Tuberculosis, Malaria & Neglected Tropical Diseases Cluster, World Health Organization, Geneva, Switzerland;
authors.forename: C
authors.initials: C
authors.lastname: Dye
authors.affiliation: <label><sup>‡</sup></label>Public Health Division, Secretariat of the Pacific Community, Noumea Cedex, New Caledonia;
authors.forename: K
authors.initials: K
authors.lastname: Viney
authors.affiliation: <label><sup>§</sup></label>National Tuberculosis Control Programme, Ministry of Health and Medical Services, Republic of Kiribati;
authors.forename: K
authors.initials: K
authors.lastname: Tabutoa
authors.affiliation: <label><sup>§</sup></label>National Tuberculosis Control Programme, Ministry of Health and Medical Services, Republic of Kiribati;
authors.forename: T
authors.initials: T
authors.lastname: Kienene
authors.affiliation: <label><sup>¶</sup></label>International Union Against Tuberculosis and Lung Disease, Paris, France;
authors.forename: K
authors.initials: K
authors.lastname: Bissell
authors.affiliation: <label>*</label>*South African Centre for Epidemiological Modelling and Analysis, Cape Town, South Africa;
authors.forename: B G
authors.initials: BG
authors.lastname: Williams
authors.affiliation: <label><sup>††</sup></label>Médecins Sans Frontières, Brussels Operational Centre, Luxembourg, Belgium;
authors.forename: R
authors.initials: R
authors.lastname: Zachariah
authors.affiliation: <label><sup>‡‡</sup></label>Sydney Emerging Infectious Disease and Biosecurity Institute and Centre for Research Excellence in Tuberculosis, University of Sydney, Sydney, New South Wales, Australia;
authors.forename: B J
authors.initials: BJ
authors.lastname: Marais
authors.affiliation: <label><sup>¶</sup></label>International Union Against Tuberculosis and Lung Disease, Paris, France;
authors.forename: A D
authors.initials: AD
authors.lastname: Harries
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D055985:Latent Tuberculosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D008297:Male; D008849:Micronesia / Q000453:epidemiology; D008875:Middle Aged; D008962:Models, Theoretical; D009169:Mycobacterium tuberculosis / Q000472:pathogenicity*; D012008:Recurrence; D013997:Time Factors; D014376:Tuberculosis / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents