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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
More...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: Suggested Citation