Abstract
Approximately 85% of tuberculosis (TB) related deaths occur in low- and middle-income countries where health resources are scarce. Effective priority setting is required to maximise the impact of limited budgets. The Optima TB tool has been developed to support analytical capacity and inform evidence-based priority setting processes for TB health benefits package design. This paper outlines the Optima TB framework and how it was applied in Belarus, an upper-middle income country in Eastern Europe with a relatively high burden of TB. Optima TB is a population-based disease transmission model, with programmatic cost functions and an optimisation algorithm. Modelled populations include age-differentiated general populations and higher-risk populations such as people living with HIV. Populations and prospective interventions are defined in consultation with local stakeholders. In partnership with the latter, demographic, epidemiological, programmatic, as well as cost and spending data for these populations and interventions are then collated. An optimisation analysis of TB spending was conducted in Belarus, using program objectives and constraints defined in collaboration with local stakeholders, which included experts, decision makers, funders and organisations involved in service delivery, support and technical assistance. These analyses show that it is possible to improve health impact by redistributing current TB spending in Belarus. Specifically, shifting funding from inpatient- to outpatient-focused care models, and from mass screening to active case finding strategies, could reduce TB prevalence and mortality by up to 45% and 50%, respectively, by 2035. In addition, an optimised allocation of TB spending could lead to a reduction in drug-resistant TB infections by 40% over this period. This would support progress towards national TB targets without additional financial resources. The case study in Belarus demonstrates how reallocations of spending across existing and new interventions could have a substantial impact on TB outcomes. This highlights the potential for Optima TB and similar modelling tools to support evidence-based priority setting.
Highlights
The past decade has seen global improvements in key TB indicators, including incidence and notifications reported by National Tuberculosis Programmes (NTPs)
Bacillus Calmette–Guerin (BCG) vaccination Testing: TST1, LPA2, and solid culture testing Mass-screening Active case finding for key populations Hospital-based treatments for drug sensitive (DS), multi drug resistant (MDR)- and XDR-TB Palliative care Involuntary isolation for MDRand XDR-TB
45% of total TB spending was invested in hospital-focused interventions (US$27.6 million), of which 74% was on drug-resistant TB (DR-TB) treatment (US$20.3 million)
Summary
The past decade has seen global improvements in key TB indicators, including incidence and notifications reported by National Tuberculosis Programmes (NTPs). While global active TB incidence has decreased at an annual rate of 1.5–1.8%, this fell short of the 4–5% decline required by 2020 to meet the End TB strategy milestones [1, 2]. To meet the End TB 2035 targets of treating at least 90% of all incident cases [3], the rate of active TB notification (estimated at 69% of incidence in 2018) [4] must increase substantially. Governments and NTPs are not able to fully finance all available interventions. As such choices must be made regarding which interventions to prioritise and at what level of coverage for populations in need
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
