Browsing by Author "Lonnroth, Knut"

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    Development and validation of a prediction model for active tuberculosis case finding among HIV-negative/unknown populations
    (Nature Research (part of Springer Nature), 2019) Shih, Yun-Ju; Ayles, Helen; Lonnroth, Knut; Claassens, Mareli; Lin, Hsien-Ho
    ENGLISH ABSTRACT: A prediction model of prevalent pulmonary tuberculosis (TB) in HIV negative/unknown individuals was developed to assist systematic screening. Data from a large TB screening trial were used. A multivariable logistic regression model was developed in the South African (SA) training dataset, using TB symptoms and risk factors as predictors. The model was converted into a scoring system for risk stratification and was evaluated in separate SA and Zambian validation datasets. The number of TB cases were 355, 176, and 107 in the SA training, SA validation, and Zambian validation datasets respectively. The area under curve (AUC) of the scoring system was 0·68 (95% CI 0·64-0·72) in the SA validation set, compared to prolonged cough (0·58, 95% CI 0·54-0·62) and any TB symptoms (0·6, 95% CI 0·56–0·64). In the Zambian dataset the AUC of the scoring system was 0·66 (95% CI 0·60–0·72). In the cost-effectiveness analysis, the scoring system dominated the conventional strategies. The cost per TB case detected ranged from 429 to 1,848 USD in the SA validation set and from 171 to 10,518 USD in the Zambian dataset. The scoring system may help targeted TB case finding under budget constraints.
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    Nutrition, diabetes and tuberculosis in the epidemiological transition
    (Public Library of Science (PLOS), 2011-06) Dye, Christopher; Trunz, Bernadette Bourdin; Lonnroth, Knut; Roglic, Gojka; Williams, Brian G.
    Background: Diabetes prevalence and body mass index reflect the nutritional profile of populations but have opposing effects on tuberculosis risk. Interactions between diabetes and BMI could help or hinder TB control in growing, aging, urbanizing populations. Methods and Findings: We compiled data describing temporal changes in BMI, diabetes prevalence and population age structure in rural and urban areas for men and women in countries with high (India) and low (Rep. Korea) TB burdens. Using published data on the risks of TB associated with these factors, we calculated expected changes in TB incidence between 1998 and 2008. In India, TB incidence cases would have increased (28% from 1.7 m to 2.1 m) faster than population size (22%) because of adverse effects of aging, urbanization, changing BMI and rising diabetes prevalence, generating an increase in TB incidence per capita of 5.5% in 10 years. In India, general nutritional improvements were offset by a fall in BMI among the majority of men who live in rural areas. The growing prevalence of diabetes in India increased the annual number of TB cases in people with diabetes by 46% between 1998 and 2008. In Korea, by contrast, the number of TB cases increased more slowly (6.1% from 40,200 to 42,800) than population size (14%) because of positive effects of urbanization, increasing BMI and falling diabetes prevalence. Consequently, TB incidence per capita fell by 7.8% in 10 years. Rapid population aging was the most significant adverse effect in Korea. Conclusions: Nutritional and demographic changes had stronger adverse effects on TB in high-incidence India than in lower-incidence Korea. The unfavourable effects in both countries can be overcome by early drug treatment but, if left unchecked, could lead to an accelerating rise in TB incidence. The prevention and management of risk factors for TB would reinforce TB control by chemotherapy. © 2011 Dye et al.
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    Translational research for tuberculosis elimination : priorities, challenges, and actions
    (Public Library of Science, 2016) Lienhardt, Christian; Lonnroth, Knut; Menzies, Dick; Balasegaram, Manica; Chakaya, Jeremiah; Cobelens, Frank; Cohn, Jennifer; Denkinger, Claudia M.; Evans, Thomas G.; Kallenius, Gunilla; Kaplan, Gilla; Kumar, Ajay M. V.; Matthiessen, Line; Mgone, Charles S.; Mizrahi, Valerie; Mukadi, Ya-diul; Nguyen, Viet Nhung; Nordstrom, Anders; Sizemore, Christine F.; Spigelman, Melvin; Squire, S. Bertel; Swaminathan, Soumya; Van Helden, Paul D.; Zumla, Alimuddin; Weyer, Karin; Weil, Diana; Raviglione, Mario
    Summary Points: • The WHO End TB Strategy, endorsed by the World Health Assembly in May 2014, has the ambitious goal of ending the global tuberculosis (TB) epidemic by 2035, with targets of a 95% decline in deaths due to TB (compared with 2015) and a 90% reduction in incidence of TB to ten cases/100,000 or less and no TB-affected household experiencing catastrophic costs due to TB. • Achieving this goal will only be possible through the development and rapid uptake of new tools, including rapid point-of-care diagnostics, safe and shorter treatment of latent TB infection and disease, and an efficacious TB vaccine, combined with efficient health systems and care provision, and actions on the social determinants of TB. • Research for TB elimination requires an intensification of efforts across a continuum from fundamental research to clinical, epidemiological, implementation, health system, and social science research. • Enhancing research along the full spectrum, from basic to implementation, and strengthening research capacity, particularly in low- and middle-income countries severely affected by the TB epidemics, is crucial for TB elimination. • The creation of a research-enabling environment that fosters and rewards high-quality research requires a broad-based, concerted effort by national governments and international donors to develop and promote TB research and research capacity at the country level and the effective engagement of all stakeholders.