dc.contributor.author | Salje, Henrik | en_US |
dc.contributor.author | Andrews, Jason R. | en_US |
dc.contributor.author | Deo, Sarang | en_US |
dc.contributor.author | Satyanarayana, Srinath | en_US |
dc.contributor.author | Sun, Amanda Y. | en_US |
dc.contributor.author | Pai, Madhukar | en_US |
dc.contributor.author | Dowdy, David W. | en_US |
dc.date.accessioned | 2014-08-13T13:59:44Z | |
dc.date.issued | 2014 | en_US |
dc.identifier.citation | Salje, Henrik, Jason R. Andrews, Sarang Deo, Srinath Satyanarayana, Amanda Y. Sun, Madhukar Pai, and David W. Dowdy. 2014. “The Importance of Implementation Strategy in Scaling Up Xpert MTB/RIF for Diagnosis of Tuberculosis in the Indian Health-Care System: A Transmission Model.” PLoS Medicine 11 (7): e1001674. doi:10.1371/journal.pmed.1001674. http://dx.doi.org/10.1371/journal.pmed.1001674. | en |
dc.identifier.issn | 1549-1277 | en |
dc.identifier.uri | http://nrs.harvard.edu/urn-3:HUL.InstRepos:12717518 | |
dc.description.abstract | Background: India has announced a goal of universal access to quality tuberculosis (TB) diagnosis and treatment. A number of novel diagnostics could help meet this important goal. The rollout of one such diagnostic, Xpert MTB/RIF (Xpert) is being considered, but if Xpert is used mainly for people with HIV or high risk of multidrug-resistant TB (MDR-TB) in the public sector, population-level impact may be limited. Methods and Findings: We developed a model of TB transmission, care-seeking behavior, and diagnostic/treatment practices in India and explored the impact of six different rollout strategies. Providing Xpert to 40% of public-sector patients with HIV or prior TB treatment (similar to current national strategy) reduced TB incidence by 0.2% (95% uncertainty range [UR]: −1.4%, 1.7%) and MDR-TB incidence by 2.4% (95% UR: −5.2%, 9.1%) relative to existing practice but required 2,500 additional MDR-TB treatments and 60 four-module GeneXpert systems at maximum capacity. Further including 20% of unselected symptomatic individuals in the public sector required 700 systems and reduced incidence by 2.1% (95% UR: 0.5%, 3.9%); a similar approach involving qualified private providers (providers who have received at least some training in allopathic or non-allopathic medicine) reduced incidence by 6.0% (95% UR: 3.9%, 7.9%) with similar resource outlay, but only if high treatment success was assured. Engaging 20% of all private-sector providers (qualified and informal [providers with no formal medical training]) had the greatest impact (14.1% reduction, 95% UR: 10.6%, 16.9%), but required >2,200 systems and reliable treatment referral. Improving referrals from informal providers for smear-based diagnosis in the public sector (without Xpert rollout) had substantially greater impact (6.3% reduction) than Xpert scale-up within the public sector. These findings are subject to substantial uncertainty regarding private-sector treatment patterns, patient care-seeking behavior, symptoms, and infectiousness over time; these uncertainties should be addressed by future research. Conclusions: The impact of new diagnostics for TB control in India depends on implementation within the complex, fragmented health-care system. Transformative strategies will require private/informal-sector engagement, adequate referral systems, improved treatment quality, and substantial resources. Please see later in the article for the Editors' Summary | en |
dc.language.iso | en_US | en |
dc.publisher | Public Library of Science | en |
dc.relation.isversionof | doi:10.1371/journal.pmed.1001674 | en |
dc.relation.hasversion | http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4098913/pdf/ | en |
dash.license | LAA | en_US |
dc.subject | Biology and Life Sciences | en |
dc.subject | Computational Biology | en |
dc.subject | Population Modeling | en |
dc.subject | Infectious Disease Modeling | en |
dc.subject | Medicine and Health Sciences | en |
dc.subject | Epidemiology | en |
dc.subject | Infectious Diseases | en |
dc.subject | Bacterial Diseases | en |
dc.subject | Tuberculosis | en |
dc.subject | Infectious Disease Control | en |
dc.title | The Importance of Implementation Strategy in Scaling Up Xpert MTB/RIF for Diagnosis of Tuberculosis in the Indian Health-Care System: A Transmission Model | en |
dc.type | Journal Article | en_US |
dc.description.version | Version of Record | en |
dc.relation.journal | PLoS Medicine | en |
dc.date.available | 2014-08-13T13:59:44Z | |
dc.identifier.doi | 10.1371/journal.pmed.1001674 | * |