Table 2.
Summary of modelled intervention scenarios and target values for China, India, and South Africa
|
China |
India |
South Africa |
|||||||
|---|---|---|---|---|---|---|---|---|---|
| Activities* | Base value | Target value† | Activities* | Base value | Target value | Activities* | Base value | Target value | |
| #1. Increase access to high quality care‡ | |||||||||
| Reduce proportion not accessing any tuberculosis care | Government subsidises tuberculosis care, and compensates patients for incurred costs | 5% | 3·75%(NTP), 0% (A) | Government subsidises diagnostic and treatment costs in private sector, expanding number of clinics and opening times of tuberculosis care | 9·5% | 4·75% (NTP), 0% (A) | Improve geographical access through outreach clinics | 5% | 0% (NTP), 0% (A) |
| Of those with care access, increase proportion accessing high quality care | Same technology and approaches available in hospital and CDC sector | 80% | 95% (NTP), 100% (A) | Government subsidises use of high quality tools and protocols in private sector | 50% | 90% (NTP), 100% (A) | Tuberculosis symptom screening for all health clinic attendees to ensure all in need receive tuberculosis diagnosis | 20% | 100% (NTP), 100% (A) |
| #2. Diagnosis of disease and MDR§ | |||||||||
| Replace smear microscopy with molecular diagnostic (eg, GeneXpert) as first-line test | Replacement of smear microscopy with molecular diagnostic in facilities | 0% | 100% (NTP), 100% (A) | Replacement of smear microscopy with molecular diagnostic in facilities | 0% | 30% (NTP), 100% (A) | Not modelled because rollout of GeneXpert has been implemented already | 100% | Not modelled |
| #3. Improve post-diagnosis care§ | |||||||||
| Reduce pretreatment loss to follow-up: first-line | Compensation for patient costs | 3% | 1·5% (NTP), 0% (A) | Provide patient incentives for treatment initiation | 10% | 5% (NTP), 0% (A) | Expand monitoring and assessment capacity, implement mhealth and outreach teams to trace patients in communities | 17% | 5% (NTP), 0% (A) |
| Reduce pretreatment loss to follow-up: MDR | Compensation of patient costs, improvements in speed of diagnosis and referral | 50% | 15% (NTP), 0% (A) | Linkage to social welfare programmes, including nutritional support | 11% | 5% (NTP), 0% (A) | As above | 50% | 15% (NTP), 0% (A) |
| Increase first-line treatment success | Implement patient support strategies including health and case management | 82% | 90% (NTP), 95% (A) | Provide incentives and linkage to welfare programmes | 75% | 85% (NTP), 90% (A) | Provide patient with adherence counselling and psychosocial support, as well as improved monitoring and evaluation | 76% | 85% (NTP), 85% (A) |
| Increase MDR treatment success | Improve patient monitoring (mhealth) and side-effect amelioration | 35% | 65% (NTP), 80% (A) | As above | 48% | 67% (NTP), 80% (A) | All of above, as well as decentralisation of electronic register | 50% | 67% (NTP), 75% (A) |
| #4. Active case finding in general population | |||||||||
| Periodically screen a proportion of the general population for tuberculosis disease | As general description | 0% | 0% (NTP), 30% (A) | As general description | 0% | 1·6% (NTP), 30% (A) | As general description | 0% | 0% (NTP), 50% (A) |
| #5. Active case finding followed by treatment of latent tuberculosis | |||||||||
| Provide LTBI screening and preventive therapy when positive to proportion of active case finding population where active tuberculosis was excluded | As general description | 0% | 0% (NTP), 100% (A) | As general description | 0% | 0% (NTP), 100% (A) | As general description | 0% | 0% (NTP), 100% (A) |
| #6. Continuous IPT for ART-receiving population | |||||||||
| Provide continuous IPT as part of ART in PLWHIV. | Not modelled | .. | .. | Not modelled | .. | .. | Includes preinitiation screening, and rescreening of those lost to follow-up | 5% | 80% (NTP), 100% (A) |
| #7. Combination | |||||||||
| Scale up all interventions simultaneously | All of above | .. | .. | All of above | .. | .. | All of above | .. | .. |
Information describes the general intervention effects to be modelled, which were adapted to fit within specific model structures (see appendix section 3 for details). Target value=absolute value. NTP=national tuberculosis programme scenario. A=advocacy scenario. PLWHIV=people living with HIV. CDC=Centers for Disease Control. mhealth=mobile health. MDR=multidrug resistant. LTBI=latent tuberculosis infection. IPT=isoniazid preventive treatment. ART=antretroviral therapy.
Summarises the activities proposed by the NTP scenario-setters to enhance current programme performance.
Scale-up to target value started in 2016 and usually reached in 2020.
High quality care describes the best performing sector of all tuberculosis care providers—eg, public sector in India, CDC sector in China.
Intervention scenarios for diagnosis (#2) and care (#3) apply to population accessing high quality care only.