Please note: All research in progress seminars are off-the-record. Any information about methodology and/or results are embargoed until publication.

Despite decades of efforts to combat tuberculosis (TB),  its control remains a major global public health challenge. India is one of the world’s TB epicenters, with over 3 million people infected and 300,000 TB deaths in 2010. The current situation exists despite the fact that India initiated World Health Organization-recommended TB disease control programs (DOTS) in the mid-1990s and achieved full population coverage by the early 2000s. Of particular concern, multi-drug resistant (MDR) TB, which is difficult and costly to treat, has increased in recent years. Factors thought to contribute to India's TB and MDR TB epidemic include changes in the population age structure, the prevalence of risk factors including smoking, less than ideal DOTS program quality, and a lack of effective diagnostic and treatment programs for individuals with MDR TB. Policy options include efforts to: improve DOTS program quality, increase coverage of MDR TB treatment, accelerate case detection especially of MDR TB cases, target TB program efforts subgroups most influential in sustaining India's TB epidemic, focus on risk factor reduction like smoking cessation efforts. With limited resources, selecting the most effective policy options quickly is extremely important -- a situation that mathematical modeling is well-suited to support. Therefore, we developed a simulation model with demographic and risk factor stratifications to understand the drivers of the TB and MDR TB epidemic in India and explore the effects of treatment on drug sensitive and MDR TB disease. Most prior TB models do not explicitly incorporate many important drivers of the epidemic (e.g. age stratification), without which accurate characterization of the population health effects of treatments can be challenging. Our analyses demonstrate the age- and smoking-specific effects of treatment on TB and on the development of mult-drug resistant TB, highlighting the intended and unintended implications of disease control programs as well as the opportunities and limits of future policy efforts to reverse these trends.

Location
MSOB X303
Medical School Office Building Room X303
1265 Welch Road
Stanford, CA 94305
» Directions/Map

FSI Contact
Christine Geibel