Monitoring linked epidemics: The case of tuberculosis and HIV

Abstract

Background: The tight epidemiological coupling between HIV and its associated opportunistic infections leads to challenges and opportunities for disease surveillance. Methodology/Principal Findings: We review efforts of WHO and collaborating agencies to track and fight the TB/HIV coepidemic, and discuss modeling - via mathematical, statistical, and computational approaches - as a means to identify disease indicators designed to integrate data from linked diseases in order to characterize how co-epidemics change in time and space. We present RTB/HIV, an index comparing changes in TB incidence relative to HIV prevalence, and use it to identify those sub-Saharan African countries with outlier TB/HIV dynamics. RTB/HIV can also be used to predict epidemiological trends, investigate the coherency of reported trends, and cross-check the anticipated impact of public health interventions. Identifying the cause(s) responsible for anomalous RTB/HIV values can reveal information crucial to the management of public health. Conclusions/ Significance: We frame our suggestions for integrating and analyzing co-epidemic data within the context of global disease monitoring. Used routinely, joint disease indicators such as RTB/HIV could greatly enhance the monitoring and evaluation of public health programs. © 2010 Sánchez et al.