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

«

April 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
·
·
·
·
·
·

Projects

Evaluating an automated system for...

We are evaluating the accuracy and cost-effectiveness of TBDx, an automated digital microscopy system, as a screening test to...

Read More

TBM-KIDS (India)

A phase 2 clinical trial of optimized treatment for pediatric tuberculous meningitis in India and Malawi

Read More

Impact of diabetes on TB treatment outcomes...

This is a study to prospectively enroll and follow TB patients co-infected with diabetes and TB patients without diabetes...

Read More

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