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Impact of Strategic Public Health Interventions to Reduce Tuberculosis Incidence in Brazil: A Bayesian Structural Time-Series Scenario Analysis

31 Pages Posted: 7 Jul 2024

See all articles by Klauss Villalva-Serra

Klauss Villalva-Serra

Oswaldo Cruz Foundation (FIOCRUZ) - Gonçalo Moniz Institute (IGM)

Beatriz Barreto-Duarte

Universidade Federal do Rio de Janeiro (UFRJ)

Moreno M. S. Rodrigues

Oswaldo Cruz Foundation (FIOCRUZ) - Laboratório de Análise e Visualização de Dados

Artur T. L. Queiroz

Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative

Leo Martinez

Boston University - Department of Epidemiology

Julio Croda

Universidade Federal de Mato Grosso - Faculty of Health Sciences; Oswaldo Cruz Foundation (FIOCRUZ)

Valeria C. Rolla

Oswaldo Cruz Foundation (FIOCRUZ)

Afranio L. Kritski

Universidade Federal do Rio de Janeiro (UFRJ) - Programa Acadêmico de Tuberculose

Marcelo Cordeiro-Santos

Universidade do Estado do Amazonas - Programa de Pós-Graduação em Medicina Tropical

Timothy R. Sterling

Vanderbilt University - Division of Infectious Diseases

Mariana Araújo-Pereira

Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative

Bruno B. Andrade

Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative; Oswaldo Cruz Foundation (FIOCRUZ) - Laboratório de Inflamação e Biomarcadores

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Abstract

Background: Despite government efforts, tuberculosis (TB) remains a major public health threat in Brazil. TB incidence in this country in 2023 was 39.8 cases per 100,000 population, far above the World Health Organization’s (WHO) goal to reduce incidence by 80% in 2030, relative to 2015. Using national-level datasets, we investigated and forecasted the estimated impact of several comprehensive public health interventions on reducing TB incidence in Brazil.

Methods: Monthly TB surveillance data (January 2018-December 2023) were collected from Brazilian national reporting systems: SINAN-TB (TB cases), SITE-TB (TB drug-resistance), and IL-TB (preventive therapy). These data were used to create a multivariable Bayesian Structural Time-Series (BSTS) model, with 5000 Monte-Carlo simulations, which identified key predictors of TB incidence and forecasted these rates from 2024 to 2030 under various scenarios.

Findings: Vulnerabilities including incarceration, TB-HIV coinfection and TB-diabetes mellitus, as well as coverages of directly observed therapy (DOT), contact investigation and preventive treatment (TPT) completion rates, were identified as key predictors of TB incidence. Under current trends, we forecasted TB incidence in Brazil to be 42·1 [34·1-49·8] per 100,000 person-years by 2030. However, a 34·2% [26·2%-47·5%] reduction in projected TB incidence was found in a scenario considering decreases in the number of TB cases among vulnerable populations. Additional reductions were seen in scenarios with increased coverage of these key TB management indicators (25·0% [18·9%-35·2%]) and by combining both interventions (56·1% [43·0%-77·2%]).

Interpretation : Our findings demonstrate how interventions focused on enhancing health policies focused in decreasing TB cases among vulnerable populations, including individuals with TB-HIV coinfection, incarcerated populations, and TB-diabetes comorbidity, along with improvements in health management indicators such as DOT participation and contact investigation coverage, as well as TPT completion rates, are effective in reducing TB incidence nationwide.

Funding: The study was supported by the Intramural Research Program of the Fundação Oswaldo Cruz (B.B.A.), Intramural Research Program of the Fundação José Silveira (B.B.A), the National Institutes of Allergy and Infectious Diseases [U01-AI069923 to T.R.S, VCR, ALK, TRS, BBA, and MCS and U01-AI115940 to B.B.A.]. KV-S and M.A-P. received a fellowship from the National Council for Scientific and Technological Development (CNPQ). A.K is a recipient of the Scientist of our State fellowship from Rio de Janeiro Research Council/FAPERJ. J.C., A.L.K., V.C.R., B.B.A, M.C.S. are fellows from the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil.

Declaration of Interest: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Ethical Approval: Data were obtained from public government databases and pre-processed by the BMoH for completeness, consistency, and removal of duplicates, following Resolution 466/12 guidelines by the National Health Council, Brazil. Informed consent was not required since no personal identifiers were present in the databases.

Keywords: Tuberculosis, Public Health, Forecasting, Vulnerabilities, Directly Observed Therapy, Tuberculosis Preventive Therapy

Suggested Citation

Villalva-Serra, Klauss and Barreto-Duarte, Beatriz and Rodrigues, Moreno M. S. and Queiroz, Artur T. L. and Martinez, Leo and Croda, Julio and Rolla, Valeria C. and Kritski, Afranio L. and Cordeiro-Santos, Marcelo and Sterling, Timothy R. and Araújo-Pereira, Mariana and Andrade, Bruno B., Impact of Strategic Public Health Interventions to Reduce Tuberculosis Incidence in Brazil: A Bayesian Structural Time-Series Scenario Analysis. Available at SSRN: https://ssrn.com/abstract=4885947 or http://dx.doi.org/10.2139/ssrn.4885947

Klauss Villalva-Serra

Oswaldo Cruz Foundation (FIOCRUZ) - Gonçalo Moniz Institute (IGM) ( email )

Beatriz Barreto-Duarte

Universidade Federal do Rio de Janeiro (UFRJ) ( email )

Athos da Silveira Ramos 149
Rio de Janeiro, 21941-909
Brazil

Moreno M. S. Rodrigues

Oswaldo Cruz Foundation (FIOCRUZ) - Laboratório de Análise e Visualização de Dados ( email )

Rio de Janeiro
Brazil

Artur T. L. Queiroz

Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative ( email )

Salvador
Brazil

Leo Martinez

Boston University - Department of Epidemiology ( email )

Julio Croda

Universidade Federal de Mato Grosso - Faculty of Health Sciences ( email )

Brazil

Oswaldo Cruz Foundation (FIOCRUZ) ( email )

Valeria C. Rolla

Oswaldo Cruz Foundation (FIOCRUZ) ( email )

Afranio L. Kritski

Universidade Federal do Rio de Janeiro (UFRJ) - Programa Acadêmico de Tuberculose ( email )

Rua Tonelero, 380 apt. 804
Copacabana, 22030-000
Brazil

Marcelo Cordeiro-Santos

Universidade do Estado do Amazonas - Programa de Pós-Graduação em Medicina Tropical ( email )

Avenida Djalma Batista, 3578
Manaus, 69050-010
Brazil

Timothy R. Sterling

Vanderbilt University - Division of Infectious Diseases ( email )

United States

Mariana Araújo-Pereira

Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative ( email )

Bruno B. Andrade (Contact Author)

Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative ( email )

Oswaldo Cruz Foundation (FIOCRUZ) - Laboratório de Inflamação e Biomarcadores ( email )

Salvador
Brazil

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