Can Australia eliminate TB? Modelling immigration strategies for reaching MDG targets in a low‐transmission setting

• Main Authors: Justin T. Denholm (Author), Emma S. McBryde (Author)
• Format: Book
• Published: Elsevier, 2014-02-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 1753-6405; 1326-0200; 10.1111/1753-6405.12161
• Keywords: latent tuberculosis infection; immigration; screening; mathematical model; public health; Public aspects of medicine; RA1-1270
• Source: Australian and New Zealand Journal of Public Health, Vol 38, Iss 1, Pp 78-82 (2014)

Abstract Background: The 2050 Millennium Development Goals (MDG) for tuberculosis (TB) aim for elimination of TB as a public health issue. We used a mathematical modelling approach to evaluate the feasibility of this target in a low‐prevalence setting with immigration‐related strategies directed at latent tuberculosis. Methods: We used a stochastic individual‐based model to simulate tuberculosis disease among immigrants to Victoria, Australia; a representative low‐transmission setting. A variety of screening and treatment approaches aimed at preventing reactivation of latent infection were applied to evaluate overall tuberculosis incidence reduction and rates of multidrug resistant disease. Results: Without additional intervention, tuberculosis incidence was predicted to reach 34.5 cases/million by 2050. Strategies involving the introduction of an available screening/treatment combination reduced TB incidence to between 16.9-23.8 cases/million, and required screening of 136-427 new arrivals for each case of TB prevented. Limiting screening to higher incidence regions of origin was less effective but more efficient. Conclusions: Public health strategies targeting latent tuberculosis infection in immigrants may substantially reduce tuberculosis incidence in a low prevalence region. However, immigration‐focused strategies cannot achieve the 2050 MDG and alternative or complementary approaches are required.