Article Sidebar
Published:
Jan 30, 2024Article Details
Copyright remains in the Author’s name. The work is licensed under a Creative Commons Attribution - Noncommercial Works License. Authors are required to complete and sign an Author Agreement form that outlines Author and Publisher rights and terms of publication. The Agreement form should be uploaded along with other submissions files and any submission will be considered incomplete without it [forthcoming].
Material submitted for publication in the SAMJ is accepted provided it has not been published or submitted for publication elsewhere. Please inform the editorial team if the main findings of your paper have been presented at a conference and published in abstract form, to avoid copyright infringement. The SAMJ does not hold itself responsible for statements made by the authors.
Previously published images
If an image/figure has been previously published, permission to reproduce or alter it must be obtained by the authors from the original publisher and the figure legend must give full credit to the original source. This credit should be accompanied by a letter indicating that permission to reproduce the image has been granted to the author/s. This letter should be uploaded as a supplementary file during submission.
Main Article Content
Impact of interventions for tuberculosis prevention and care in South Africa – A systematic review of mathematical modelling studies
Abstract
Background. Substantial additional efforts are needed to prevent, find and successfully treat tuberculosis (TB) in South Africa (SA). In the past decade, an increasing body of mathematical modelling research has investigated the population-level impact of TB prevention and care interventions. To date, this evidence has not been assessed in the SA context.
Objective. To systematically review mathematical modelling studies that estimated the impact of interventions towards the World Health Organization’s End TB Strategy targets for TB incidence, TB deaths and catastrophic costs due to TB in SA.
Methods. We searched the PubMed, Web of Science and Scopus databases for studies that used transmission-dynamic models of TB in SA and reported on at least one of the End TB Strategy targets at population level. We described study populations, type of interventions and their target groups, and estimates of impact and other key findings. For studies of country-level interventions, we estimated average annual percentage declines (AAPDs) in TB incidence and mortality attributable to the intervention.
Results. We identified 29 studies that met our inclusion criteria, of which 7 modelled TB preventive interventions (vaccination, antiretroviral treatment (ART) for HIV, TB preventive treatment (TPT)), 12 considered interventions along the care cascade for TB (screening/case finding, reducing initial loss to follow-up, diagnostic and treatment interventions), and 10 modelled combinations of preventive and care-cascade interventions. Only one study focused on reducing catastrophic costs due to TB. The highest impact of a single intervention was estimated in studies of TB vaccination, TPT among people living with HIV, and scale-up of ART. For preventive interventions, AAPDs for TB incidence varied between 0.06% and 7.07%, and for care-cascade interventions between 0.05% and 3.27%.
Conclusion. We describe a body of mathematical modelling research with a focus on TB prevention and care in SA. We found higher estimates of impact reported in studies of preventive interventions, highlighting the need to invest in TB prevention in SA. However, study heterogeneity and inconsistent baseline scenarios limit the ability to compare impact estimates between studies. Combinations, rather than single interventions, are likely needed to reach the End TB Strategy targets in SA.
