Strategies for treating latent multiple-drug resistant tuberculosis: a decision analysis.

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2012

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Abstract

BACKGROUND: The optimal treatment for latent multiple-drug resistant tuberculosis infection remains unclear. In anticipation of future clinical trials, we modeled the expected performance of six potential regimens for treatment of latent multiple-drug resistant tuberculosis. METHODS: A computerized Markov model to analyze the total cost of treatment for six different regimens: Pyrazinamide/ethambutol, moxifloxacin monotherapy, moxifloxacin/pyrazinamide, moxifloxacin/ethambutol, moxifloxacin/ethionamide, and moxifloxacin/PA-824. Efficacy estimates were extrapolated from mouse models and examined over a wide range of assumptions. RESULTS: In the base-case, moxifloxacin monotherapy was the lowest cost strategy, but moxifloxacin/ethambutol was cost-effective at an incremental cost-effectiveness ratio of $21,252 per quality-adjusted life-year. Both pyrazinamide-containing regimens were dominated due to their toxicity. A hypothetical regimen of low toxicity and even modest efficacy was cost-effective compared to "no treatment." CONCLUSION: In our model, moxifloxacin/ethambutol was the preferred treatment strategy under a wide range of assumptions; pyrazinamide-containing regimens fared poorly because of high rates of toxicity. Although more data are needed on efficacy of treatments for latent MDR-TB infection, data on toxicity and treatment discontinuation, which are easier to obtain, could have a substantial impact on public health practice.

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10.1371/journal.pone.0030194

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Holland, David P, Gillian D Sanders, Carol D Hamilton and Jason E Stout (2012). Strategies for treating latent multiple-drug resistant tuberculosis: a decision analysis. PLoS One, 7(1). p. e30194. 10.1371/journal.pone.0030194 Retrieved from https://hdl.handle.net/10161/13892.

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Scholars@Duke

Hamilton

Carol Dukes Hamilton

Professor Emeritus of Medicine

Carol Dukes Hamilton, MD, MHS is a Professor of Medicine, Emeritus, in the Infectious Diseases Division, Department of Medicine, Duke University Medical Center.  She has nearly 40 years of experience spanning clinical care, research, public health, and global leadership. She served as clinician and full-time faculty at Duke University Medical Center from 1991 until 2008, concentrating on outpatient and inpatient clinical care (HIV/AIDS, tuberculosis [TB], and routine infectious disease problems). She expanded the nascent Antibiotic Decision Support Team (ADST) and helped establish the Division’s research program in Dar es Salaam, and later Moshi, Tanzania. While at Duke, Dr. Hamilton led the North Carolina TB Control Program in Raleigh, from 2001-2008, serving as the TB Controller for the State.  After achieving Full Professor, with Tenure status at Duke, she was recruited to Family Health International (now FHI 360) to lead development of their TB research portfolio of work, and subsequently led all TB programmatic work as well, working in numerous countries in sub-Saharan Africa (primarily Zambia, Mozambique and Nigeria), and Asia (primarily China, Myanmar, Indonesia, Cambodia), while maintaining her Duke affiliation as a Consulting Professor.  She served in several leadership positions at FHI 360, including Director of Scientific Affairs in the largest unit, the Global Health, Population & Nutrition Group, where she oversaw the quality of research done globally in health and nutrition at the organization. Dr. Hamilton has over 100 peer-reviewed publications, mostly focused on HIV/AIDS, TB and the intersection between the two diseases.  Dr. Hamilton has won numerous awards including the CDC’s Charles C. Shepard Science Award (2012), the National TB Controllers Association’s Robert Koch Award (2012), the International TB Control Cooperation Award from the China Clinical Center on Tuberculosis and the National TB Society (2014), and the US CDC’s Fred Gordin TBTC award (2018).  She retired from FHI 360 in 2018, and is now Professor, Emeritus at Duke, providing mentoring and consultation at both Duke and FHI 360.


Key words: Tuberculosis; mycobacteria other than TB (MOTT); HIV/AIDS; HAART; genomics; global health; public health;

Stout

Jason Eric Stout

Professor of Medicine

My research focuses on the epidemiology, natural history, and treatment of tuberculosis and nontuberculous mycobacterial infections. I am also interested in the impact of HIV infection on mycobacterial infection and disease, and in examining health disparities as they relate to infectious diseases, particularly in immigrant populations.


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