The epidemiological advantage of preferential targeting of tuberculosis control at the poor.

Published Date:

04/01/2015

Source:

The International Journal of Tuberculosis and Lung Disease, Volume 19, Number 4, 1 April 2015, pp. 375-380(6)

Authors:

Andrews JR, Basu S, Dowdy DW, Murray MB

External link

Original Article

Tuberculosis (TB) remains disproportionately concentrated among the poor, yet known determinants of TB reactivation may fail to explain observed disparities in disease rates according to wealth. Reviewing data on TB disparities in India and the wealth distribution of known TB risk factors, we describe how social mixing patterns could be contributing to TB disparities. Wealth-assortative mixing, whereby individuals are more likely to be in contact with others from similar socio-economic backgrounds, amplifies smaller differences in risk of TB, resulting in large population-level disparities. As disparities and assortativeness increase, TB becomes more difficult to control, an effect that is obscured by looking at population averages of epidemiological parameters, such as case detection rates. We illustrate how TB control efforts may benefit from preferential targeting toward the poor. In India, an equivalent-scale intervention could have a substantially greater impact if targeted at those living below the poverty line than with a population-wide strategy. In addition to potential efficiencies in targeting higher-risk populations, TB control efforts would lead to a greater reduction in secondary TB cases per primary case diagnosed if they were preferentially targeted at the poor. We highlight the need to collect programmatic data on TB disparities and explicitly incorporate equity considerations into TB control plans.

Events

«

May 2017

»
S
M
T
W
T
F
S
·
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
·
·
·

Projects

Quantitative assessment of the tipping point...

Quantitative methods will be used to study Mtb dynamics to determine the tipping point for macrophage infection, which depends...

Read More

Understanding the impact of combined TB and...

We are developing models to understand the overlap of TB and HIV in three epidemiologically distinct settings (Canada, India,...

Read More

The role of cell wall lipids in pathogenesis...

This study will use a combination of transcriptional, lipidomic, genetic, and imaging techniques to investigate whether...

Read More

Understanding the role of repeat testing and...

We have developed a Markov model of serial IGRA testing to help improve testing algorithms with TST vs. IGRA in low-risk...

Read More