@article {4635,
	title = {Integrating Community-Based Interventions to Reverse the Convergent TB/HIV Epidemics in Rural South Africa.},
	journal = {PloS one},
	volume = {10},
	year = {2015},
	month = {2015},
	pages = {e0126267},
	abstract = {The WHO recommends integrating interventions to address the devastating TB/HIV co-epidemics in South Africa, yet integration has been poorly implemented and TB/HIV control efforts need strengthening. Identifying infected individuals is particularly difficult in rural settings. We used mathematical modeling to predict the impact of community-based, integrated TB/HIV case finding and additional control strategies on South Africa{\textquoteright}s TB/HIV epidemics. We developed a model incorporating TB and HIV transmission to evaluate the effectiveness of integrating TB and HIV interventions in rural South Africa over 10 years. We modeled the impact of a novel screening program that integrates case finding for TB and HIV in the community, comparing it to status quo and recommended TB/HIV control strategies, including GeneXpert, MDR-TB treatment decentralization, improved first-line TB treatment cure rate, isoniazid preventive therapy, and expanded ART. Combining recommended interventions averted 27\% of expected TB cases (95\% CI 18-40\%) 18\% HIV (95\% CI 13-24\%), 60\% MDR-TB (95\% CI 34-83\%), 69\% XDR-TB (95\% CI 34-90\%), and 16\% TB/HIV deaths (95\% CI 12-29). Supplementing these interventions with annual community-based TB/HIV case finding averted a further 17\% of TB cases (44\% total; 95\% CI 31-56\%), 5\% HIV (23\% total; 95\% CI 17-29\%), 8\% MDR-TB (68\% total; 95\% CI 40-88\%), 4\% XDR-TB (73\% total; 95\% CI 38-91\%), and 8\% TB/HIV deaths (24\% total; 95\% CI 16-39\%). In addition to increasing screening frequency, we found that improving TB symptom questionnaire sensitivity, second-line TB treatment delays, default before initiating TB treatment or ART, and second-line TB drug efficacy were significantly associated with even greater reductions in TB and HIV cases. TB/HIV epidemics in South Africa were most effectively curtailed by simultaneously implementing interventions that integrated community-based TB/HIV control strategies and targeted drug-resistant TB. Strengthening existing TB and HIV treatment programs is needed to further reduce disease incidence.},
	issn = {1932-6203},
	doi = {10.1371/journal.pone.0126267},
	author = {Gilbert, Jennifer A and Long, Elisa F and Brooks, Ralph P and Friedland, Gerald H and Moll, Anthony P and Townsend, Jeffrey P and Galvani, Alison P and Shenoi, Sheela V}
}
