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How Can Operational Research Help to Eliminate Tuberculosis in the Asia Pacific Region?
Open AccessArticle

Strategic Planning for Tuberculosis Control in the Republic of Fiji

1
Department of Medicine, the University of Melbourne and Department of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
2
Ministry of Health and Medical Services, Suva, Fiji
3
Australian Institute of Tropical Health and Medicine, James Cook University and Department of Medicine, University of Melbourne, Melbourne 3000, Australia
4
Ministry of Health and Medical Services, Suva, Fiji
5
Department of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
6
Australian Institute of Tropical Health and Medicine, James Cook University, Townsville 4811; Australia
*
Author to whom correspondence should be addressed.
Trop. Med. Infect. Dis. 2019, 4(2), 71; https://doi.org/10.3390/tropicalmed4020071
Received: 20 February 2019 / Revised: 17 April 2019 / Accepted: 22 April 2019 / Published: 24 April 2019
(This article belongs to the Special Issue Tuberculosis Elimination in the Asia-Pacific)
The tuberculosis (TB) health burden in Fiji has been declining in recent years, although challenges remain in improving control of the diabetes co-epidemic and achieving adequate case detection across the widely dispersed archipelago. We applied a mathematical model of TB transmission to the TB epidemic in Fiji that captured the historical reality over several decades, including age stratification, diabetes, varying disease manifestations, and incorrect diagnoses. Next, we simulated six intervention scenarios that are under consideration by the Fiji National Tuberculosis Program. Our findings show that the interventions were able to achieve only modest improvements in disease burden, with awareness raising being the most effective intervention to reduce TB incidence, and treatment support yielding the highest impact on mortality. These improvements would fall far short of the ambitious targets that have been set by the country, and could easily be derailed by moderate increases in the diabetes burden. Furthermore, the effectiveness of the interventions was limited by the extensive pool of latent TB infection, because the programs were directed at only active cases, and thus were unlikely to achieve the desired reductions in burden. Therefore, it is essential to address the co-epidemic of diabetes and treat people with latent TB infection. View Full-Text
Keywords: tuberculosis; health policy; disease modelling; simulation; epidemiology; public health tuberculosis; health policy; disease modelling; simulation; epidemiology; public health
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Ragonnet, R.; Underwood, F.; Doan, T.; Rafai, E.; Trauer, J.; McBryde, E. Strategic Planning for Tuberculosis Control in the Republic of Fiji. Trop. Med. Infect. Dis. 2019, 4, 71.

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