Annals ATS | 09/11/2020
The Centers for Disease Control and Prevention attributes only 13% of incident tuberculosis (TB) disease in the United States to recent (?2 yr) transmission; nearly all of the remaining incident cases of TB disease are believed to occur via reactivation of latent TB infection (LTBI) acquired by individuals earlier in their lives (1). It is estimated that up to 13 million people would test positive on the tuberculin skin test, and 9 (6–15) million people have untreated LTBI in the United States (2, 3). As such, treatment of LTBI is central to the current U.S. TB elimination strategy (4). Treatment regimens such as 3 months of isoniazid and rifapentine (3HP), 4 months of rifampin (4R), and 6–9 months of isoniazid are efficacious in preventing TB disease (5–8), but effectiveness of any LTBI regimen in general populations may be limited by suboptimal levels of treatment initiation and completion (8, 9) and by discontinuation because of adverse effects (AEs) (7, 9). Novel regimens with shorter duration of therapy, such as 6 weeks of daily 600-mg doses of rifapentine (6wP), which is currently being evaluated in a phase III clinical trial, may have important benefits, particularly if determined to be noninferior to 3HP and 9 months of isoniazid with lower discontinuation rates (10).
We evaluated the epidemiological impact of implementing 6wP as a replacement for currently used regimens to treat LTBI in the United States using six models of TB transmission and epidemiology (11–13) as a part of the Centers for Disease Control and Prevention’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Epidemiologic and Economic Modeling Agreement (http://www.cdc.gov/nchhstp/neema/index.html). These models included Harvard University model for the United State (HVD-US) (11), University of California, San Francisco model of California (UCSF-CA) (12), and Johns Hopkins School of Public Health models for California (JHSPH-CA), Florida (JHSPH-FL), New York (JHSPH-NY), and Texas (JHSPH-TX) (13). We projected the number of TB cases that would occur during the 16-year period from 2020 to 2035 under the assumption that 6wP is used to treat LTBI compared with an assumed standard-of-care baseline, with 72% initiation, 78% completion, and 93% efficacy rates (Table 1).
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