Periodic Active Case Finding for TB When to Look 英文参考文献.docVIP

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Periodic Active Case Finding for TB When to Look 英文参考文献.doc

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Periodic Active Case Finding for TB When to Look 英文参考文献

PeriodicActiveCaseFindingforTB:WhentoLook? PeterJ.Dodd1*,RichardG.White1,ElizabethL.Corbett1,2 1LondonSchoolofHygieneandTropicalMedicine,London,UnitedKingdom,2Malawi-LiverpoolWellcomeTrustClinicalResearchProgramme,Blantyre,Malawi Abstract Objective:Toinvestigatethefactorsinfluencingtheperformanceandcost-efficacyofperiodicroundsofactivecasefinding (ACF)forTB. Methods:AmathematicalmodelofTBdynamicsandperiodicACF(PACF)intheHIVera,simplifiedbyassumingconstant prevalenceoflatentTBinfection,isanalyzedforfeaturesthatcontrolinterventionoutcome,measuredascasesavertedand casesfound.ExplanatoryvariablesincludebaselineTBincidence,intervalbetweenPACFrounds,anddifferentroutineand PACFcase-detectionratesamongHIV-infectedanduninfectedTBcases. Findings:PACFcanbecost-savingovera10yeartimeframeifthecost-per-roundislowerthanathresholdproportionalto initialincidenceandcost-per-case-treated.Morecasesareavertedathigherbaselineincidencerates,whenmorepotent PACF strategiesareused, intervals betweenPACF roundsareshorter, andwhen theratioof HIV-negativetopositiveTB cases detected is higher. More costly approaches, e.g. radiographic screening, can be as cost-effective as less costly alternativesifPACFcase-detectionishigherand/orimplementationlessfrequent. Conclusion:PeriodicACFcanbothimprovecontrolandsavemedium-termhealthcarecostsinhighTBburdensettings. GreatercostsofhighlyeffectivePACFatfrequent(e.g.yearly)intervalsmaybeoffsetbyhighernumbersofcasesavertedin populationswithhighbaselineTBincidence,higherprevalenceofHIV-uninfectedcases,highercostsper-case-treated,and more effective routine case-detection. Less intensive approaches may still be cost-neutral or cost-saving in populations lackingoneormoreofthesekeydeterminants. Citation:DoddPJ,WhiteRG,CorbettEL(2011)PeriodicActiveCaseFindingforTB:WhentoLook?PLoSONE6(12):e29130.doi:10.1371/journal.pone.0029130 Editor:SrikanthPrasadTripathy,NationalAIDSResearchInstitute,India ReceivedJune30,2011;AcceptedNovember21,2011;PublishedDecember22,2011 Co