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A modelling framework to support the selection and implementation of new tuberculosis diagnostic tools

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Lin, H-H, Langley, Ivor ORCID: https://orcid.org/0000-0002-9275-6731, Mwenda, R, Doulla, B, Egwaga, S, Millington, K A, Mann, Gillian, Murray, M, Squire, Bertie ORCID: https://orcid.org/0000-0001-7173-9038 and Cohen, T (2011) 'A modelling framework to support the selection and implementation of new tuberculosis diagnostic tools'. International Journal of Tuberculosis and Lung Disease, Vol 15, Issue 8, pp. 996-1004.

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Abstract

Efforts to stimulate technological innovation in the diagnosis of tuberculosis 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 tools’ test characteristics (e.g. sensitivity and specificity), 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, HIV co-infection, 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 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 the performance of health systems which impact TB transmission dynamics which, in turn, result in further changes to the demands on the health system. We demonstrate the use of a simplified model to support the rational choice of diagnostic strategy based on health systems requirements, patient outcomes, and population level TB impact.

Item Type: Article
Subjects: QY Clinical Pathology > QY 4 General works
WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General)
WF Respiratory System > Tuberculosis > WF 220 Diagnosis. Prognosis
Faculty: Department: Groups (2002 - 2012) > Clinical Group
Digital Object Identifer (DOI): https://doi.org/10.5588/ijtld.11.0062
Depositing User: Users 43 not found.
Date Deposited: 14 Jul 2011 15:51
Last Modified: 06 Feb 2018 13:03
URI: https://archive.lstmed.ac.uk/id/eprint/2098

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