Optimizing Investments in Mozambique's Tuberculosis Response : Results of a Tuberculosis Allocative Efficiency Study

Mozambique National TB Program ; World Bank ; Optima Consortium for Decision Sciences ; Burnet Institute

World Bank, Washington, DC

关键词: TUBERCULOSIS;    EPIDEMIC;    DEMOGRAPHIC TRENDS;    HIV;    ANTIRETROVIRAL THERAPY;   

RP-ID  :  149522

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

This allocative efficiency analysisintended to assess Mozambique's progress towards TBstrategic targets, and provide decision support for TBstrategy using a combined TB epidemiological component andan economic and program analysis framework (Optima TB).Input data were collected from NTP sources, the WHO, andvarious TB implementers. Our model indicates decliningfuture trends in TB prevalence, incidence and relateddeaths. However, the case detection rate (52 percent)remains one of the biggest hurdles. Mozambique, however,could cut TB prevalence and TB deaths by 20 percent, and TBincidence by 11 percent by allocating resources optimally.Specifically, this would entail (i) doubling the rate ofhousehold contact tracing for notified cases, (ii) screeningall PLHIV during their routine outpatient visits, and (iii)focusing on community outreach activities among keypopulations such as prisoners, cross-border miners andcommunity health workers. In addition, scaling up ARTcoverage from 55 percent (current/ 2017) to 90 percent by2035 is projected to reduce new TB cases among PLHIV by over50 percent (in 2035). Furthermore, our analysis shows thathigher levels of TB spending lead to more rapid reductionsin TB incidence. However, the rates of reduction associatedwith large increases in expenditure (up to 200 percent ofcurrent spending levels) begin to slow in the medium termand it is unlikely that the national TB response can deliveron the 2025 milestones and 2035 End-TB targets.