Abstract
The tuberculosis (TB) health burden in Fiji has been declining in recent years, although challenges remain in improving control of the diabetes co-epidemic and achieving adequate case detection across the widely dispersed archipelago. We applied a mathematical model of TB transmission to the TB epidemic in Fiji that captured the historical reality over several decades, including age stratification, diabetes, varying disease manifestations, and incorrect diagnoses. Next, we simulated six intervention scenarios that are under consideration by the Fiji National Tuberculosis Program. Our findings show that the interventions were able to achieve only modest improvements in disease burden, with awareness raising being the most effective intervention to reduce TB incidence, and treatment support yielding the highest impact on mortality. These improvements would fall far short of the ambitious targets that have been set by the country, and could easily be derailed by moderate increases in the diabetes burden. Furthermore, the effectiveness of the interventions was limited by the extensive pool of latent TB infection, because the programs were directed at only active cases, and thus were unlikely to achieve the desired reductions in burden. Therefore, it is essential to address the co-epidemic of diabetes and treat people with latent TB infection.
Highlights
IntroductionTuberculosis (TB) remains endemic in the Republic of Fiji (hereafter referred to as Fiji) with an estimated incidence of 59 new cases per 100,000 population in 2016 (95% confidence interval [CI] 45–75) [1]
Tuberculosis (TB) remains endemic in the Republic of Fiji with an estimated incidence of 59 new cases per 100,000 population in 2016 (95% confidence interval [CI] 45–75) [1]
The fight against TB in the South Pacific Ocean region in general and in Fiji in particular is complicated by local challenges, including a substantial part of the population living in isolated rural areas and high rates of type 2 diabetes mellitus (T2DM) [2]
Summary
Tuberculosis (TB) remains endemic in the Republic of Fiji (hereafter referred to as Fiji) with an estimated incidence of 59 new cases per 100,000 population in 2016 (95% confidence interval [CI] 45–75) [1]. The TB epidemic in Fiji is significantly driven by T2DM, which is on the rise and affects around 16% of the Fijian population aged 25 years and above [3]. Patients are first born into the model with the time-variant birth rate fit to World Bank data (Figure S1) and proportions of births vaccinated and unvaccinated are split according to the vaccination coverage data from the World Health Organization (WHO) or the United Nations Children’s Fund (UNICEF) (Figure S2). Population-wide natural mortality was parameterised to data from the World Bank (Figure S3) and was applied to all the compartments. The proportion of the population with T2DM was considered as a time-variant parameter and applied to the oldest age group only (Figure S9).
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