Skip to main content Accessibility help
×
Home

Strategic investment in tuberculosis control in the Republic of Bulgaria

  • T. N. Doan (a1) (a2), T. Varleva (a3), M. Zamfirova (a3), M. Tyufekchieva (a3), A. Keshelava (a3) (a4), K. Hristov (a3) (a4), A. Yaneva (a3) (a4), B. Gadzheva (a3) (a4), S. Zhang (a5), S. Irbe (a5), R. Ragonnet (a1) (a6) (a7), E. S. McBryde (a1) (a2) and J. M. Trauer (a7)...

Abstract

As Bulgaria transitions away from Global Fund grant, robust estimates of the comparative impact of the various response strategies under consideration are needed to ensure sustained effectiveness of the tuberculosis (TB) programme. We tailored an established mathematical model for TB control to the epidemic in Bulgaria to project the likely outcomes of seven intervention scenarios. Under existing programmatic conditions projected forward, the country's targets for achieving TB elimination in the coming decades will not be achieved. No interventions under consideration were predicted to accelerate the baseline projected reduction in epidemiological indicators significantly. Discontinuation of the ‘Open Doors’ program and activities of non-governmental organisations would result in a marked exacerbation of the epidemic (increasing incidence in 2035 by 6–8% relative to baseline conditions projected forward). Changing to a short course regimen for multidrug-resistant TB (MDR-TB) would substantially decrease MDR-TB mortality (by 21.6% in 2035 relative to baseline conditions projected forward). Changing to ambulatory care for eligible patients would not affect TB burden but would be markedly cost-saving. In conclusion, Bulgaria faces important challenges in transitioning to a primarily domestically-financed TB programme. The country should consider maintaining currently effective programs and shifting towards ambulatory care to ensure program sustainability.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Strategic investment in tuberculosis control in the Republic of Bulgaria
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Strategic investment in tuberculosis control in the Republic of Bulgaria
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Strategic investment in tuberculosis control in the Republic of Bulgaria
      Available formats
      ×

Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Author for correspondence: T. N. Doan, E-mail: tan.doan@uqconnect.edu.au

References

Hide All
1.World Health Organization (2017) Global tuberculosis report 2016. Available at http://www.who.int/tb/publications/global_report/en/ (Accessed 19 July 2018).
2.EURACTV (2016) Tuberculosis still raging in Eastern Europe. Available at https://www.euractiv.com/section/health-consumers/news/report-tuberculosis-still-raging-in-eastern-europe/ (Accessed 15 August 2018).
3.Council of Ministers – Republic of Bulgaria (2016) National programme for prevention and control of tuberculosis in the republic of Bulgaria for the period 2016–2020. Sofia, Bulgaria: Council of Ministers.
4.Borissova, A-M et al. (2015) Changes in the prevalence of diabetes mellitus in Bulgaria (2006–2012). Clinical Medicine Insights: Endocrinology and Diabetes 8, 4145.
5.International Diabetes Federation (2015) The diabetic retinopathy barometer report: Bulgaria. Available at https://www.idf.org/our-activities/care-prevention/eye-health/dr-barometer/14-diabetic-retinopathy-barometer.html (Accessed 15 August 2018).
6.World Health Organization (2014) The END TB Strategy. Available at http://who.int/tb/post2015_TBstrategy.pdf?ua=1 (Accessed 15 August 2018).
7.Trauer, JM et al. (2017) Modular programming for tuberculosis control, the ‘AuTuMN’ platform. BMC Infectious Diseases 17, 546.
8.Cruz, AT and Starke, JR (2007) Clinical manifestations of tuberculosis in children. Paediatric Respiratory Reviews 8, 107117.
9.Matlow, A, Robb, M and Goldman, C (2003) Infection control and paediatric tuberculosis: a practical guide for the practicing paediatrician. Paediatrics & Child Health 8, 624626.
10.Tostmann, A et al. (2008) Tuberculosis transmission by patients with smear-negative pulmonary tuberculosis in a large cohort in the Netherlands. Clinical Infectious Diseases 47, 11351142.
11.Ragonnet, R et al. (2017) Optimally capturing latency dynamics in models of tuberculosis transmission. Epidemics 21, 3947.
12.Trauer, JM et al. (2016) Risk of active tuberculosis in the five years following infection…15%? Chest 149, 516525.
13.Jeon, CY and Murray, MB (2008) Diabetes mellitus increases the risk of active tuberculosis: a systematic review of 13 observational studies. PLoS Medicine 5, e152.
14.Tiemersma, EW et al. (2011) Natural history of tuberculosis: duration and fatality of untreated pulmonary tuberculosis in HIV negative patients: a systematic review. PLoS One 6, e17601.
15.van Deun, A et al. (2010) Short, highly effective, and inexpensive standardized treatment of multidrug-resistant tuberculosis. American Journal of Respiratory and Critical Care Medicine 182, 684692.
16.Piubello, A et al. (2014) High cure rate with standardised short-course multidrug-resistant tuberculosis treatment in Niger: no relapses. The International Journal of Tuberculosis and Lung Disease 18, 11881194.
17.Kuaban, C et al. (2015) High effectiveness of a 12-month regimen for MDR-TB patients in Cameroon. The International Journal of Tuberculosis and Lung Disease 19, 517524.
18.Aung, KJ et al. (2014) Successful ‘9-month Bangladesh regimen’ for multidrug-resistant tuberculosis among over 500 consecutive patients. The International Journal of Tuberculosis and Lung Disease 18, 11801187.
19.Martins, N, Morris, P and Kelly, PM (2009) Food incentives to improve completion of tuberculosis treatment: randomised controlled trial in Dili, Timor-Leste. BMJ 339, b4248.
20.Lutge, E et al. (2013) Economic support to improve tuberculosis treatment outcomes in South Africa: a pragmatic cluster-randomized controlled trial. Trials 14, 154.
21.Ciobanu, A et al. (2014) Do incentives improve tuberculosis treatment outcomes in the Republic of Moldova? Public Health in Action 4, 5963.
22.Bassili, A et al. (2013) A systematic review of the effectiveness of hospital- and ambulatory-based management of multidrug-resistant tuberculosis. The American Journal of Tropical Medicine and Hygiene 89, 271280.
23.Fitzpatrick, C and Floyd, K (2012) A systematic review of the cost and cost effectiveness of treatment for multidrug-resistant tuberculosis. Pharmacoeconomics 30, 6380.
24.Horter, S et al. (2014) ‘Home is where the patient is’: a qualitative analysis of a patient-centred model of care for multi-drug resistant tuberculosis. BMC Health Services 14, 81.
25.Williams, AO, Makinde, OA and Ojo, M (2016) Community-based management vs. traditional hospitalization in treatment of drug-resistant tuberculosis: a systematic review and meta-analysis. Global Health Research and Policy 1, 10.
26.Dye, C et al. (2013) Prospects for tuberculosis elimination. The Annual Review of Public Health 34, 271286.
27.Hill, PC et al. (2014) Mass treatment to eliminate tuberculosis from an island population. The International Journal of Tuberculosis and Lung Disease 18, 899904.
28.Ragonnet, R et al. (2017) Is IPT more effective in high-burden settings? Modelling the effect of tuberculosis incidence on IPT impact. The International Journal of Tuberculosis and Lung Disease 21, 6066.
29.Houben, RM et al. (2016) TIME impact – a new user-friendly tuberculosis (TB) model to inform TB policy decisions. BMC Medicine 14, 56.

Keywords

Type Description Title
WORD
Supplementary materials

Doan et al. supplementary material
Doan et al. supplementary material

 Word (5.0 MB)
5.0 MB

Strategic investment in tuberculosis control in the Republic of Bulgaria

  • T. N. Doan (a1) (a2), T. Varleva (a3), M. Zamfirova (a3), M. Tyufekchieva (a3), A. Keshelava (a3) (a4), K. Hristov (a3) (a4), A. Yaneva (a3) (a4), B. Gadzheva (a3) (a4), S. Zhang (a5), S. Irbe (a5), R. Ragonnet (a1) (a6) (a7), E. S. McBryde (a1) (a2) and J. M. Trauer (a7)...

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed