Integrating Community-Based Interventions to Reverse the Convergent TB/HIV Epidemics in Rural South Africa

Gilbert, Jennifer A.; Long, Elisa F.; Brooks, Ralph P.; Friedland, Gerald H.; Moll, Anthony P.; Townsend, Jeffrey P.; Galvani, Alison P.; Shenoi, Sheela V.

doi:10.1371/journal.pone.0126267

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Integrating Community-Based Interventions to Reverse the Convergent TB/HIV Epidemics in Rural South Africa

Published Date:

May 04 2015

Publisher's site:

http://dx.doi.org/10.1371/journal.pone.0126267 New Site Icon

Source:

PLoS One. 2015; 10(5).

[PDF-2.98 MB]

Details:

Personal Authors:

Gilbert, Jennifer A. ; Long, Elisa F. ; Brooks, Ralph P. ; Friedland, Gerald H. ; Moll, Anthony P. ; ... More ▼

Keywords:

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Pubmed ID:

25938501

Pubmed Central ID:

PMC4418809

Description:

The WHO recommends integrating interventions to address the devastating TB/HIV co-epidemics in South Africa, yet integration has been poorly implemented and TB/HIV control efforts need strengthening. Identifying infected individuals is particularly difficult in rural settings. We used mathematical modeling to predict the impact of community-based, integrated TB/HIV case finding and additional control strategies on South Africa's TB/HIV epidemics. We developed a model incorporating TB and HIV transmission to evaluate the effectiveness of integrating TB and HIV interventions in rural South Africa over 10 years. We modeled the impact of a novel screening program that integrates case finding for TB and HIV in the community, comparing it to status quo and recommended TB/HIV control strategies, including GeneXpert, MDR-TB treatment decentralization, improved first-line TB treatment cure rate, isoniazid preventive therapy, and expanded ART. Combining recommended interventions averted 27% of expected TB cases (95% CI 18-40%) 18% HIV (95% CI 13-24%), 60% MDR-TB (95% CI 34-83%), 69% XDR-TB (95% CI 34-90%), and 16% TB/HIV deaths (95% CI 12-29). Supplementing these interventions with annual community-based TB/HIV case finding averted a further 17% of TB cases (44% total; 95% CI 31-56%), 5% HIV (23% total; 95% CI 17-29%), 8% MDR-TB (68% total; 95% CI 40-88%), 4% XDR-TB (73% total; 95% CI 38-91%), and 8% TB/HIV deaths (24% total; 95% CI 16-39%). In addition to increasing screening frequency, we found that improving TB symptom questionnaire sensitivity, second-line TB treatment delays, default before initiating TB treatment or ART, and second-line TB drug efficacy were significantly associated with even greater reductions in TB and HIV cases. TB/HIV epidemics in South Africa were most effectively curtailed by simultaneously implementing interventions that integrated community-based TB/HIV control strategies and targeted drug-resistant TB. Strengthening existing TB and HIV treatment programs is needed to further reduce disease incidence.

Document Type:

Journal Article

Collection(s):

CDC Public Access

Funding:

1K23AI089260/AI/NIAID NIH HHS/United States
1U01GH000524-01/GH/CGH CDC HHS/United States
2U01GM087719/GM/NIGMS NIH HHS/United States
5U01GM105627/GM/NIGMS NIH HHS/United States
K23 AI089260/AI/NIAID NIH HHS/United States
R01DA015612/DA/NIDA NIH HHS/United States
R01DA025932/DA/NIDA NIH HHS/United States
R24TW007988/TW/FIC NIH HHS/United States

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