Webtool, ‘Examining the impact of targeted testing and treatment for latent tuberculosis infection across 4 states’

Webtool, ‘Examining the impact of targeted testing and treatment for latent tuberculosis infection across 4 states’

This tool is a web application that shows the projected epidemiological impact, corresponding costs, and cost-effectiveness, of increased targeted testing and treatment on tuberculosis incidence among different high-risk populations in four states: California, Florida, New York and Texas. Targeted testing and treatment (TTT) is an important TB prevention and control strategy that is used to identify, evaluate, and treat people who are at high risk for latent TB infection (LTBI) or at high risk for active TB disease once infected. Based on state-level TB transmission models, members of the CAMP team at Johns Hopkins and CDC estimated the impact of TTT (compared to the absence of any additional intervention) as the percent reduction in the projected baseline TB incidence, from 2016 through 2025, among five high-risk groups (people who are non-US-born, diabetic, HIV-positive, homeless or incarcerated) in the four most populous US states (California, Florida, New York and Texas). Costs of TTT (from the healthcare system perspective, in 2016 dollars) and incremental cost effectiveness (cost per quality-adjusted life year [QALY] gained) are evaluated over a 30 year horizon based on outputs from the epidemiological model (i.e., numbers of people screened, diagnosed and treated; number of TB cases averted) and combine these with state-specific estimates of the direct medical cost of TB screening, diagnosis, and treatment. Users can observe the impact of TTT among individually, and compare these values to the total impact, cost profile and cost effectiveness of TTT if implemented across all five high-risk groups together in each state. While many state health departments may be aware of which populations in their specific state are at highest risk for TB disease, showing the projected impact of TB interventions within these key populations across all states provides a basis for measurable improvement. Importantly, differences in TTT impact between states may mean that different states have different needs and priorities regarding the reduction of TB incidence by risk group. User-friendly online tools can thus aid state and local jurisdictions in decision-making about resource allocation in TB control and prioritization of TB elimination activities, and are complementary to the state TB epidemiology reports. 

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