| Literature DB >> 28784094 |
James McCracken Trauer1, Romain Ragonnet2, Tan Nhut Doan3, Emma Sue McBryde4.
Abstract
BACKGROUND: Tuberculosis (TB) is now the world's leading infectious killer and major programmatic advances will be needed if we are to meet the ambitious new End TB Targets. Although mathematical models are powerful tools for TB control, such models must be flexible enough to capture the complexity and heterogeneity of the global TB epidemic. This includes simulating a disease that affects age groups and other risk groups differently, has varying levels of infectiousness depending upon the organ involved and varying outcomes from treatment depending on the drug resistance pattern of the infecting strain.Entities:
Keywords: Disease transmission, infectious; Global health; Models, biological; Software; Tuberculosis; Tuberculosis, multidrug-resistant
Mesh:
Year: 2017 PMID: 28784094 PMCID: PMC5547473 DOI: 10.1186/s12879-017-2648-6
Source DB: PubMed Journal: BMC Infect Dis ISSN: 1471-2334 Impact factor: 3.090
Fig. 1Modular structure of the AuTuMN platform
Fig. 2Compartmental structure of transmission dynamic model. Recovery to susceptible compartments after successful completion of treatment, default with return to active disease, death and intervention-related flows are universally implemented but not presented in this Figure. Greater number of overlapping rectangles indicates greater degrees of model stratification, although number of rectangles is arbitrary. Flows presented are: 1, births; 2, infection; 3, progression to active disease; 4 and 5, spontaneous recovery; 6, missed diagnosis due to insensitivity of the diagnostic algorithm; 7, return to care seeking; 8, detection with correct assignment by drug resistance profile; 9, detection with incorrect assignment by drug resistance profile; 10 and 11, commencement on treatment. *“Organ involvement” refers to whether patient has smear-positive, smear-negative or extrapulmonary disease
Characteristics of modules
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| Graphical user interface | Accepts user inputs to determine: |
| Spreadsheet reader | Reads data according to country selected in Graphical user interface |
| Data processing | Creates data structures with a format interpretable by the Model modules |
| Curve fitting | Derives polynomial spline functions to represent parameters (often interventions) scaling over time (See Fig. |
| Model runner | Creates and runs model objects according to the purpose selected in the Graphical user interface |
| Disease-specific (TB) modelb | Defines stratifications and their interaction by: |
| General transmission dynamic model | Defines fundamental structures of transmission dynamic model which are not pathogen-specific (i.e. components common to any deterministic, compartmental, ordinary differential equation-based model of population-level infectious disease transmission), including: |
| Output modules | Creates Word™ and Excel™ tables of epidemiological and economic outputs and graphical (PNG) figures to illustrate: |
aNote that not all types of stratification apply to all compartments (e.g. susceptible population not stratified by drug resistance of infecting organism), see Fig. 2. bThis module is not a stand-alone class, but instead inherits general methods from the General transmission dynamic model module, adding TB-specific methods to the class. Abbreviations: TB, tuberculosis; PNG, portable network graphics; UNICEF, The United Nations International Children’s Emergency Fund; WHO, World Health Organization.
Illustration of approach coding
Fig. 3Fitting of time-variant parameters to data. Black dots, loaded data for the Philippines from – World Bank (birth rate), UNICEF (vaccination coverage) and Global TB Report (death rate on treatment and treatment success rate). Solid lines, time-variant parameter functions – black, baseline scenario; red, example scenario of scale-up of vaccination coverage
Fig. 4Visual outputs from model calibration to data for epidemiological indicators. Data are from Global TB Report 2016 for the Philippines. Progressively darker parallel grey lines, successive model runs accepted by the Metropolis-Hastings algorithm; coloured shaded areas (where presented), calibration data uncertainty ranges; thin central coloured lines in shaded areas, calibration data point-estimates. This example calibration is to reported incidence data from 1990 to 2016 with weighting to emphasise calibration to more recent years for which data are available, with three uncertainty parameters (effective contact rate, duration of untreated TB, case-fatality of untreated TB), with values starting from values found during a manual calibration
Fig. 5Cost-coverage curves for example scenarios. Cost-coverage curves for four example scenarios in the Philippines. ACF, active case finding. Progressively darker shading indicates progression in cost-coverage relationship over time, in five year increments from 2015 to 2035 (as relationships are dependent on the size of the population targeted by each intervention)