PDF(Pubmed)
Abstract：
OBJECTIVE: To estimate the potential impact of expanding services offered by the Joint Effort for Elimination of Tuberculosis (JEET), the largest private sector engagement initiative for tuberculosis (TB) in India.
METHODS: We developed a mathematical model of TB transmission dynamics, coupled with a cost model.
METHODS: Ahmedabad and New Delhi, two cities with contrasting levels of JEET coverage.
METHODS: Estimated patients with TB in Ahmedabad and New Delhi.
METHODS: We investigated the epidemiological impact of expanding three different public-private support agency (PPSA) services: provider recruitment, uptake of cartridge-based nucleic acid amplification tests and uptake of adherence support mechanisms (specifically government supplied fixed-dose combination drugs), all compared with a continuation of current TB services.
RESULTS: Our results suggest that in Delhi, increasing the use of adherence support mechanisms among private providers should be prioritised, having the lowest incremental cost-per-case-averted between 2020 and 2035 of US$170 000 (US$110 000-US$310 000). Likewise in Ahmedabad, increasing provider recruitment should be prioritised, having the lowest incremental cost-per-case averted of US$18 000 (US$12 000-US$29 000).
CONCLUSIONS: Results illustrate how intervention priorities may vary in different settings across India, depending on local conditions, and the existing degree of uptake of PPSA services. Modelling can be a useful tool for identifying these priorities for any given setting.
METHODS: We developed a mathematical model of TB transmission dynamics, coupled with a cost model.
METHODS: Ahmedabad and New Delhi, two cities with contrasting levels of JEET coverage.
METHODS: Estimated patients with TB in Ahmedabad and New Delhi.
METHODS: We investigated the epidemiological impact of expanding three different public-private support agency (PPSA) services: provider recruitment, uptake of cartridge-based nucleic acid amplification tests and uptake of adherence support mechanisms (specifically government supplied fixed-dose combination drugs), all compared with a continuation of current TB services.
RESULTS: Our results suggest that in Delhi, increasing the use of adherence support mechanisms among private providers should be prioritised, having the lowest incremental cost-per-case-averted between 2020 and 2035 of US$170 000 (US$110 000-US$310 000). Likewise in Ahmedabad, increasing provider recruitment should be prioritised, having the lowest incremental cost-per-case averted of US$18 000 (US$12 000-US$29 000).
CONCLUSIONS: Results illustrate how intervention priorities may vary in different settings across India, depending on local conditions, and the existing degree of uptake of PPSA services. Modelling can be a useful tool for identifying these priorities for any given setting.
摘要：
目的：评估消除结核病联合努力（JEET）提供的扩大服务的潜在影响，印度最大的私营部门结核病（TB）参与计划。
方法：我们开发了结核病传输动力学的数学模型，再加上成本模型。
方法：艾哈迈德达巴德和新德里，两个城市的JEET覆盖率不同。
方法：阿默达巴德和新德里估计的结核病患者。
方法：我们调查了扩大三种不同的公私支持机构（PPSA）服务的流行病学影响：提供者招募，吸收基于药筒的核酸扩增测试和吸收粘附支持机制（特别是政府提供的固定剂量组合药物），与当前结核病服务的延续相比。
结果：我们的结果表明，在德里，应优先考虑在私人提供者中增加对遵守支持机制的使用，在2020年至2035年期间，避免的每例增量成本最低，为17万美元(11万美元-31万美元)。同样在Ahmedabad,应优先考虑增加提供者的招聘，每个案例的最低增量成本为18000美元(12000美元-29000美元)。
结论：结果说明了在整个印度不同的环境中，干预优先级可能会有所不同。根据当地情况，以及PPSA服务的现有吸收程度。建模可以是识别任何给定设置的这些优先级的有用工具。
方法：我们开发了结核病传输动力学的数学模型，再加上成本模型。
方法：艾哈迈德达巴德和新德里，两个城市的JEET覆盖率不同。
方法：阿默达巴德和新德里估计的结核病患者。
方法：我们调查了扩大三种不同的公私支持机构（PPSA）服务的流行病学影响：提供者招募，吸收基于药筒的核酸扩增测试和吸收粘附支持机制（特别是政府提供的固定剂量组合药物），与当前结核病服务的延续相比。
结果：我们的结果表明，在德里，应优先考虑在私人提供者中增加对遵守支持机制的使用，在2020年至2035年期间，避免的每例增量成本最低，为17万美元(11万美元-31万美元)。同样在Ahmedabad,应优先考虑增加提供者的招聘，每个案例的最低增量成本为18000美元(12000美元-29000美元)。
结论：结果说明了在整个印度不同的环境中，干预优先级可能会有所不同。根据当地情况，以及PPSA服务的现有吸收程度。建模可以是识别任何给定设置的这些优先级的有用工具。
