Abstract
BackgroundDevelopment of new, effective, and affordable tuberculosis (TB) therapies has been identified as a critical priority for global TB control. As new candidates emerge from the global TB drug pipeline, the potential impacts of novel, shorter regimens on TB incidence and mortality have not yet been examined.Methods and FindingsWe used a mathematical model of TB to evaluate the expected benefits of shortening the duration of effective chemotherapy for active pulmonary TB. First, we considered general relationships between treatment duration and TB dynamics. Next, as a specific example, we calibrated the model to reflect the current situation in the South-East Asia region. We found that even with continued and rapid progress in scaling up the World Health Organization's DOTS strategy of directly observed, short-course chemotherapy, the benefits of reducing treatment duration would be substantial. Compared to a baseline of continuing DOTS coverage at current levels, and with currently available tools, a 2-mo regimen introduced by 2012 could prevent around 20% (range 13%–28%) of new cases and 25% (range 19%–29%) of TB deaths in South-East Asia between 2012 and 2030. If effective treatment with existing drugs expands rapidly, overall incremental benefits of shorter regimens would be lower, but would remain considerable (13% [range 8%–19%] and 19% [range 15%–23%] reductions in incidence and mortality, respectively, between 2012 and 2030). A ten-year delay in the introduction of new drugs would erase nearly three-fourths of the total expected benefits in this region through 2030.ConclusionsThe introduction of new, shorter treatment regimens could dramatically accelerate the reductions in TB incidence and mortality that are expected under current regimens—with up to 2- or 3-fold increases in rates of decline if shorter regimens are accompanied by enhanced case detection. Continued progress in reducing the global TB burden will require a balanced approach to pursuing new technologies while promoting wider implementation of proven strategies.
Highlights
Tuberculosis (TB) persists as a leading global cause of death
The introduction of new, shorter treatment regimens could dramatically accelerate the reductions in TB incidence and mortality that are expected under current regimens—with up to 2- or 3-fold increases in rates of decline if shorter regimens are accompanied by enhanced case detection
The cornerstone of global TB control efforts led by the World Health Organization (WHO) is the DOTS strategy, which relies on short-course chemotherapy for individuals with active pulmonary TB, with drugs administered under the direct observation of health workers
Summary
Tuberculosis (TB) persists as a leading global cause of death. In 2003, nearly 9 million new cases of active pulmonary TB and 2 million deaths from TB were reported [1]. Following the Millennium Declaration, endorsed by consensus of the members of the United Nations [7], targets relating to global TB control have been guided by the Millennium Development Goals—the aim of having ‘‘halted by 2015 and begun to reverse the incidence of malaria and other major diseases’’ [8] Extending this objective to include other indicators of progress against TB beyond reductions in incidence, the Stop TB partnership further resolved to halve TB prevalence and death rates between 1990 and 2015 [9]. Central to DOTS is ‘‘directly observed short-course chemotherapy.’’ To cure TB, several antibiotics have to be taken daily for 6 months Patients must complete this treatment, even if they feel better sooner, to prevent relapse and the emergence of drug-resistant bacteria. The DOTS approach ensures that patients do this by having trained observers watch them swallow each dose of their medication for the entire 6-month period
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