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Tuberculosis epidemics driven by HIV: is prevention better than cure?

Tuberculosis epidemics driven by HIV: is prevention better than cure?
Tuberculosis epidemics driven by HIV: is prevention better than cure?
Objective: To compare the benefits of tuberculosis (TB) treatment with TB and HIV prevention for the control of TB in regions with high HIV prevalence.
Design and methods: A compartmental difference equation model of TB and HIV has been developed and fitted to time series and other published data using Bayesian methods. The model is used to compare the effectiveness of TB chemotherapy with three strategies for prevention: highly active antiretroviral therapy (HAART), the treatment of latent TB infection (TLTI) and the reduction of HIV transmission.
Results: Even where the prevalence of HIV infection is high, finding and curing active TB is the most effective way to minimize the number of TB cases and deaths over the next 10 years. HAART can be as effective, but only with very high levels of coverage and compliance. TLTI is comparatively ineffective over all time scales. Reducing HIV incidence is relatively ineffective in preventing TB and TB deaths over 10 years but is much more effective over 20 years.
Conclusions: In countries where the spread of HIV has led to a substantial increase in the incidence of TB, TB control programmes should maintain a strong emphasis on the treatment of active TB. To ensure effective control of TB in the longer term, methods of TB prevention should be carried out in addition to, but not as a substitute for, treating active cases.
tuberculosis, HIV, epidemiology, mathematical modelling, bayesian methods, antiretroviral therapy, DOTS, treatment of latent TB infection
0269-9370
2501-2508
Currie, Christine S.M.
dcfd0972-1b42-4fac-8a67-0258cfdeb55a
Williams, Brian G.
35236c71-cd95-42bd-9e26-455d1ac36b98
Cheng, Russell C.H.
a4296b4e-7693-4e5f-b3d5-27b617bb9d67
Dye, Christopher
73ab1d1e-80ee-496e-9765-6842739fd843
Currie, Christine S.M.
dcfd0972-1b42-4fac-8a67-0258cfdeb55a
Williams, Brian G.
35236c71-cd95-42bd-9e26-455d1ac36b98
Cheng, Russell C.H.
a4296b4e-7693-4e5f-b3d5-27b617bb9d67
Dye, Christopher
73ab1d1e-80ee-496e-9765-6842739fd843

Currie, Christine S.M., Williams, Brian G., Cheng, Russell C.H. and Dye, Christopher (2003) Tuberculosis epidemics driven by HIV: is prevention better than cure? AIDS, 17 (17), 2501-2508.

Record type: Article

Abstract

Objective: To compare the benefits of tuberculosis (TB) treatment with TB and HIV prevention for the control of TB in regions with high HIV prevalence.
Design and methods: A compartmental difference equation model of TB and HIV has been developed and fitted to time series and other published data using Bayesian methods. The model is used to compare the effectiveness of TB chemotherapy with three strategies for prevention: highly active antiretroviral therapy (HAART), the treatment of latent TB infection (TLTI) and the reduction of HIV transmission.
Results: Even where the prevalence of HIV infection is high, finding and curing active TB is the most effective way to minimize the number of TB cases and deaths over the next 10 years. HAART can be as effective, but only with very high levels of coverage and compliance. TLTI is comparatively ineffective over all time scales. Reducing HIV incidence is relatively ineffective in preventing TB and TB deaths over 10 years but is much more effective over 20 years.
Conclusions: In countries where the spread of HIV has led to a substantial increase in the incidence of TB, TB control programmes should maintain a strong emphasis on the treatment of active TB. To ensure effective control of TB in the longer term, methods of TB prevention should be carried out in addition to, but not as a substitute for, treating active cases.

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More information

Published date: 2003
Keywords: tuberculosis, HIV, epidemiology, mathematical modelling, bayesian methods, antiretroviral therapy, DOTS, treatment of latent TB infection
Organisations: Operational Research

Identifiers

Local EPrints ID: 29631
URI: https://eprints.soton.ac.uk/id/eprint/29631
ISSN: 0269-9370
PURE UUID: 40437d02-b36e-407a-bec5-969431c7f796
ORCID for Christine S.M. Currie: ORCID iD orcid.org/0000-0002-7016-3652

Catalogue record

Date deposited: 12 May 2006
Last modified: 20 Jul 2019 01:02

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