title: Tuberculosis control in South African gold mines: mathematical modeling of a trial of community-wide isoniazid preventive therapy.
abstract: A recent major cluster randomized trial of screening, active disease treatment, and mass isoniazid preventive therapy for 9 months during 2006-2011 among South African gold miners showed reduced individual-level tuberculosis incidence but no detectable population-level impact. We fitted a dynamic mathematical model to trial data and explored 1) factors contributing to the lack of population-level impact, 2) the best-achievable impact if all implementation characteristics were increased to the highest level achieved during the trial ("optimized intervention"), and 3) how tuberculosis might be better controlled with additional interventions (improving diagnostics, reducing treatment delay, providing isoniazid preventive therapy continuously to human immunodeficiency virus-positive people, or scaling up antiretroviral treatment coverage) individually and in combination. We found the following: 1) The model suggests that a small proportion of latent infections among human immunodeficiency virus-positive people were cured, which could have been a key factor explaining the lack of detectable population-level impact. 2) The optimized implementation increased impact by only 10%. 3) Implementing additional interventions individually and in combination led to up to 30% and 75% reductions, respectively, in tuberculosis incidence after 10 years. Tuberculosis control requires a combination prevention approach, including health systems strengthening to minimize treatment delay, improving diagnostics, increased antiretroviral treatment coverage, and effective preventive treatment regimens.
authors: Emilia
authors: E
authors: Vynnycky
authors: Tom
authors: T
authors: Sumner
authors: Katherine L
authors: KL
authors: Fielding
authors: James J
authors: JJ
authors: Lewis
authors: Andrew P
authors: AP
authors: Cox
authors: Richard J
authors: RJ
authors: Hayes
authors: Elizabeth L
authors: EL
authors: Corbett
authors: Gavin J
authors: GJ
authors: Churchyard
authors: Alison D
authors: AD
authors: Grant
authors: Richard G
authors: RG
authors: White
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D006046:Gold; D015658:HIV Infections / Q000150:complications; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use*; D008875:Middle Aged; D008906:Mining; D008962:Models, Theoretical; D015980:Public Health Practice / Q000706:statistics & numerical data*; D013019:South Africa; D014376:Tuberculosis / Q000150:complications / Q000517:prevention & control*
chemical_list: D000995:Antitubercular Agents; D006046:Gold; D007538:Isoniazid
keywords: mass community-wide isoniazid preventive therapy; mathematical model; tuberculosis