Evaluation of tuberculosis control policies using computer simulation

Timothy F. Brewer, S. Jody Heymann, Graham A. Colditz, Mary E. Wilson, Kenneth Auerbach, David Kane, Harvey V. Fineberg

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


Objective. - To develop more effective methods to assess tuberculosis (TB) control strategies so we can meet national goals for the elimination of TB in the United States. Design. - Using a semi-Markov model that divided the US population into 3 age groups and 18 clinical states based on disease status and risk for TB and human immunodeficiency virus (HIV) infection, we measured the effects of 5 changes in TB policy, introduced singly and in combination: (1) increased coverage and (2) improved efficacy of preventive therapy, (3) increased coverage and (4) improved efficacy of treatment, and (5) introduction of BCG vaccination. Results. - A BCG vaccination program that reached 10% of eligible children and 1% of eligible adults each year would produce a 17% reduction in cases and an 11% decline in deaths over 10 years. Preventive therapy programs among the general population would have little effect on the number of TB cases, but a program targeting HIV-infected patients would reduce HIV-associated TB cases and deaths 14% to 20%. A 10% improvement in the coverage and efficacy of both preventive therapy and treatment, coupled with the BCG vaccination program, would lead to a 47% decline in TB cases and a 50% decline in TB deaths relative to baseline over 10 years. Conclusions. - Improvements in treatment coverage or effectiveness alone are unlikely to reach established national goals for the elimination of TB. These goals can be achieved through a combination of improvements in current programs with targeted preventive therapy and BCG vaccination programs.

Original languageEnglish
Pages (from-to)1898-1903
Number of pages6
JournalJournal of the American Medical Association
Issue number23
StatePublished - Dec 18 1996
Externally publishedYes

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