569. MDR-TB Treatment as Prevention: Modeling the Population-Level Impact of Expanded Treatment for Multidrug-Resistant Tuberculosis
Session: Poster Abstract Session: TB: Multidrug Resistant TB
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • IDWeek poster 201510 EAKendall MDR-TB Treatment as Prevention.pdf (702.4 kB)
  • Background: In 2013, approximately 480,000 people developed new active multidrug-resistant tuberculosis (MDR-TB), while only 97,000 people started on treatment for MDR-TB. Individuals with untreated MDR-TB are infectious, but the contribution of insufficient treatment to ongoing epidemic transmission of MDR-TB remains poorly defined.

    Methods: We constructed a dynamic transmission model of an MDR-TB epidemic in a representative East/Southeast Asian setting, calibrated using a country (Vietnam) with high-quality TB data. Using approximate Bayesian computation, we investigated a wide array of potential epidemic trajectories consistent with current notification data and known TB epidemiology. Within these data-consistent trajectories, we investigated the impact of improving access to MDR-TB diagnosis and treatment on ten-year projections of MDR-TB incidence and mortality.

    Results: Despite an overall projected decline in TB incidence, our data-consistent simulations suggested that MDR-TB incidence would rise by 17% (95% Uncertainty Range [UR] -38% to +137%) between 2015 and 2025 under continued 2013 treatment practices. But if, by 2017, all patients with previously-treated TB could be tested for drug susceptibility, and 85% of those with MDR-TB could be placed on second-line treatment, then our model projects that MDR-TB incidence in 2025 could be reduced by 26% (95% UR 4-52%) relative to projections under continued current practice. If this treatment could be implemented via a novel second-line regimen with similar effectiveness and toxicity as current first-line therapy, a 52% (95% UR 19-72%) reduction in MDR-TB incidence, relative to projections under current practice, could be achieved by 2025. 

    Conclusion: Diagnosing and treating MDR-TB reduces transmission and therefore decreases MDR-TB incidence at the population level. Focusing MDR diagnostic efforts on previously-treated cases is an efficient and effective approach. Expansion of diagnosis and treatment should be prioritized as an essential strategy for preventing the spread of MDR-TB.

    Emily Kendall, MD1, Andrew Azman, PhD2, Frank Cobelens, MD, PhD3 and David Dowdy, MD, PhD2, (1)Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, (2)Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, (3)Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands

    Disclosures:

    E. Kendall, None

    A. Azman, None

    F. Cobelens, None

    D. Dowdy, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.