Impact of enhanced tuberculosis diagnosis in South Africa: A mathematical model of expanded culture and drug susceptibility testing

摘要: South Africa has high rates of tuberculosis (TB), including multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains. Expanding access to culture drug susceptibility testing (DST) for TB diagnosis may help control this epidemic, but the potential impact existing novel diagnostics is uncertain. By fitting World Health Organization epidemiological estimates, we developed a compartmental difference-equation model TB/HIV epidemic among African adults. Performing DST in 37% new cases 85% previously treated was projected save 47,955 lives (17.2% reduction mortality, 95% simulation interval (S.I.) 8.9-24.4%), avert 7,721 MDR-TB (14.1% reduction, S.I. 5.3-23.8%), prevent 46.6% deaths (95% 32.6-56.0%) over 10 years. Used alone, expanded did not reduce XDR-TB incidence, they enhanced transmission-reduction strategies, such as respiratory isolation. In Africa, expanding could substantially TB, particularly MDR-TB, mortality. Control will require additional interventions, which be by improved diagnosis.