{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T14:52:34Z","timestamp":1789570354496,"version":"build-2803163510"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2021,12,15]],"date-time":"2021-12-15T00:00:00Z","timestamp":1639526400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["5T32AI052074-13"],"award-info":[{"award-number":["5T32AI052074-13"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"US Civilian Research and Development Foundation","award":["USB-31150-XX-13"],"award-info":[{"award-number":["USB-31150-XX-13"]}]},{"name":"Clinical and Translational Sciences Institute","award":["1UL1TR001430"],"award-info":[{"award-number":["1UL1TR001430"]}]},{"name":"Providence\/Boston Center for AIDS Research","award":["P30AI042853"],"award-info":[{"award-number":["P30AI042853"]}]},{"name":"Boston University\/Rutgers Tuberculosis Research Unit","award":["U19AI111276"],"award-info":[{"award-number":["U19AI111276"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,9,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Undernutrition is the leading cause of tuberculosis (TB) in India and is associated with increased TB mortality. Undernutrition also decreases quality of life and economic productivity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We assessed the cost-effectiveness of providing augmented rations to undernourished Indians through the government\u2019s Targeted Public Distribution System (TPDS). We used Markov state transition models to simulate disease progression and mortality among undernourished individuals in 3 groups: general population, household contacts (HHCs) of people living with TB, and persons living with human immunodeficiency virus (HIV). The models calculate costs and outcomes (TB cases, TB deaths, and disability-adjusted life years [DALYs]) associated with a 2600 kcal\/day diet for adults with body mass index (BMI) of 16\u201318.4\u00a0kg\/m2 until they attain a BMI of 20\u00a0kg\/m2 compared to a status quo scenario wherein TPDS rations are unchanged. We employed deterministic and probabilistic sensitivity analyses to test result robustness.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Over 5 years, augmented rations could avert 81% of TB cases and 88% of TB deaths among currently undernourished Indians. Correspondingly, this intervention could forestall 78% and 48% of TB cases and prevent 88% and 70% of deaths among undernourished HHCs and persons with HIV, respectively. Augmented rations resulted in 10-fold higher resolution of undernutrition and were highly cost-effective with (incremental cost-effectiveness ratio [ICER] of $470\/DALY averted). ICER was lower for HHCs ($360\/DALY averted) and the HIV population ($250\/DALY averted).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>A robust nutritional intervention would be highly cost-effective in reducing TB incidence and mortality while reducing chronic undernutrition in India.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciab1033","type":"journal-article","created":{"date-parts":[[2021,12,13]],"date-time":"2021-12-13T20:17:11Z","timestamp":1639426631000},"page":"577-585","source":"Crossref","is-referenced-by-count":37,"title":["Nutritional Supplementation Would Be Cost-Effective for Reducing Tuberculosis Incidence and Mortality in India: The Ration Optimization to Impede Tuberculosis (ROTI-TB) Model"],"prefix":"10.1093","volume":"75","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4233-0871","authenticated-orcid":false,"given":"Pranay","family":"Sinha","sequence":"first","affiliation":[{"name":"Section of Infectious Diseases, Department of Internal Medicine, School of Medicine, Boston University , Boston, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subitha L","family":"Lakshminarayanan","sequence":"additional","affiliation":[{"name":"Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Puducherry , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chelsie","family":"Cintron","sequence":"additional","affiliation":[{"name":"Section of Infectious Diseases, Department of Internal Medicine, School of Medicine, Boston University , Boston, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prakash Babu","family":"Narasimhan","sequence":"additional","affiliation":[{"name":"Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Puducherry , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsey M","family":"Locks","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Boston University College of Health and Rehabilitation Sciences: Sargent College , Boston, Massachusetts , USA"},{"name":"Department of Global Health, Boston University School of Public Health , Boston, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nalin","family":"Kulatilaka","sequence":"additional","affiliation":[{"name":"Susilo Institute for Ethics in a Global Economy, Boston University Questrom School of Business , Boston, Massachusetts , 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USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne F","family":"Liu","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital , Boston, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"C Robert","family":"Horsburgh","sequence":"additional","affiliation":[{"name":"Section of Infectious Diseases, Department of Internal Medicine, School of Medicine, Boston University , Boston, Massachusetts , USA"},{"name":"Department of Global Health, Boston University School of Public Health , Boston, Massachusetts , USA"},{"name":"Department of Epidemiology, Boston University School of Public Health , Boston, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Acuna-Villaorduna","sequence":"additional","affiliation":[{"name":"Section of Infectious Diseases, Department of Internal Medicine, School of Medicine, Boston University , Boston, Massachusetts , 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