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Year: 2019 Publisher: Washington, D.C. : The World Bank,
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South Africa remains a high-burden country for tuberculosis (TB) and multi-drug resistant TB (MDR-TB) with an underlying generalised HIV epidemic. TB funding must therefore be allocated to interventions which provide high impact to prevent TB transmission, identify TB cases and treat them successfully. This report presents the findings from a pilot application of the Optima TB model in Gauteng Province, where many challenges remain to sustainably reduce TB. The modelling analysis focused on relevant intervention scenarios and optimal resource allocation to achieve the 2022 TB targets, using the mathematical optimisation feature of the tool. Findings suggest that further reductions in TB prevalence and deaths are possible through improved allocative efficiency. Several scenarios highlight opportunities especially in HIV negative populations by improving the TB care cascade with higher diagnosis rates, enhanced linkage to treatment and better MDR treatment outcomes using shorter drug regimens. The same budget allocated differently could, by 2022, reduce active TB infections by up to 40 and reduce TB deaths by up to 30 perent among HIV positive and HIV negative populations. The study provided valuable input into the refinement of the Optima TB model, especially for the HIV/TB co-epidemic setting. The model outputs support Gauteng's focus on improving the care cascade and innovating MDR-TB treatment.
Book
Year: 2020 Publisher: Washington, D.C. : The World Bank,
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This allocative efficiency analysis intended to assess Mozambique's progress towards TB strategic targets, and provide decision support for TB strategy using a combined TB epidemiological component and an economic and program analysis framework (Optima TB). Input data were collected from NTP sources, the WHO, and various TB implementers. Our model indicates declining future trends in TB prevalence, incidence and related deaths. However, the case detection rate (52 percent) remains one of the biggest hurdles. Mozambique, however, could cut TB prevalence and TB deaths by 20 percent, and TB incidence by 11 percent by allocating resources optimally. Specifically, this would entail (i) doubling the rate of household contact tracing for notified cases, (ii) screening all PLHIV during their routine outpatient visits, and (iii) focusing on community outreach activities among key populations such as prisoners, cross-border miners and community health workers. In addition, scaling up ART coverage from 55 percent (current/ 2017) to 90 percent by 2035 is projected to reduce new TB cases among PLHIV by over 50 percent (in 2035). Furthermore, our analysis shows that higher levels of TB spending lead to more rapid reductions in TB incidence. However, the rates of reduction associated with large increases in expenditure (up to 200 percent of current spending levels) begin to slow in the medium term and it is unlikely that the national TB response can deliver on the 2025 milestones and 2035 End-TB targets.
Communicable Diseases --- Health, Nutrition and Population --- Public Health Promotion --- Tuberculosis
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