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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
A modelling framework to support the selection and implementation of new tuberculosis diagnostic tools
International Journal of Tuberculosis and Lung Disease, Volume 15, No. 8, Year 2011
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Description
Efforts to stimulate technological innovation in the diagnosis of tuberculosis (TB) have resulted in the recent introduction of several novel diagnostic tools. As these products come to market, policy makers must make difficult decisions about which of the available tools to implement. This choice should depend not only on the test characteristics (e.g., sensitivity and specificity) of the tools, but also on how they will be used within the existing health care infrastructure. Accordingly, policy makers choosing between diagnostic strategies must decide: 1) What is the best combination of tools to select? 2) Who should be tested with the new tools? and 3) Will these tools complement or replace existing diagnostics? The best choice of diagnostic strategy will likely vary between settings with different epidemiology (e.g., levels of TB incidence, human immunodeficiency virus coinfection and drug-resistant TB) and structural and resource constraints (e.g., existing diagnostic pathways, human resources and laboratory capacity). We propose a joint modelling framework that includes a tuberculosis (TB) transmission component (a dynamic epidemiological model) and a health system component (an operational systems model) to support diagnostic strategy decisions. This modelling approach captures the complex feedback loops in this system: new diagnostic strategies alter the demands on and performance of health systems that impact TB transmission dynamics which, in turn, result in further changes to demands on the health system. We demonstrate the use of a simplified model to support the rational choice of a diagnostic strategy based on health systems requirements, patient outcomes and population-level TB impact. © 2011 The Union.
Authors & Co-Authors
Lin, Hsien Ho
Taiwan, Taipei
National Taiwan University
France, Paris
International Union Against Tuberculosis and Lung Disease
Taiwan, Hualien
Mennonite Christian Hospital
Langley, Ivor
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Mwenda, Reuben
Malawi, Lilongwe
Ministry of Health Malawai
Doulla, Basra Esmail
Tanzania, Dar es Salaam
Ministry of Health and Social Welfare
Egwaga, Saidi M.
Tanzania, Dar es Salaam
Ministry of Health and Social Welfare
Millington, Kerry A.
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Mann, Gillian Hazel
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Murray, Megan B.
United States, Boston
Harvard T.h. Chan School of Public Health
Squire, S. Bertel
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Cohen, Ted
United States, Boston
Harvard T.h. Chan School of Public Health
United States, Boston
Brigham and Women's Hospital
Statistics
Citations: 38
Authors: 10
Affiliations: 8
Identifiers
Doi:
10.5588/ijtld.11.0062
ISSN:
10273719
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study