Abstract
Tuberculosis (TB) is a growing problem worldwide, especially with the emergence and high prevalence of multidrug-resistant strains. We develop a metapopulation model for TB spread, which is particularly suited to investigating transmission between areas of high and low prevalence. A case study of cross-border transmission in the Torres Strait region of Australia and Papua New Guinea (PNG) is considered and a sensitivity analysis is conducted. We find that only 6 of the 50 parameters analysed are important to the cumulative number of clinically active TB patients in the entire region. Of these, only the detection rate in PNG is found to be an important intervention parameter. We therefore give insight into the extent the area with the high burden of TB (PNG in the case study) is dominating the TB dynamics of the entire region. Furthermore, the sensitivity analysis results give insight into the data that most important to collect and refine, which is found to be data relating to the PNG parameters.
Highlights
Dual epidemics of HIV and tuberculosis (TB), and the associated multidrug-resistant TB (MDR-TB) are of increasing concern worldwide
There was little qualitative and small quantitative differences in the outcome of the sensitivity analyses of the total or Papua New Guinea (PNG)-only populations, which is discussed later. This is due to the dominance of the PNG dynamics on the overall incidence of TB in the entire region
The analysis for Australian sub-populations is confined to Table 1, where the sensitivity of intervention parameters is considered
Summary
Dual epidemics of HIV and tuberculosis (TB), and the associated multidrug-resistant TB (MDR-TB) are of increasing concern worldwide. The aim of the case study is to identify the factors that most affect TB transmission in the Torres Strait region. 5–10% of those infected with TB progress to clinically apparent TB within 2 years [5]. The remainder stay latently infected, with 5–10% progressing to clinically apparent TB over a 20 year period [6]. Those with clinically apparent TB are further divided into extra-pulmonary and pulmonary TB, with the pulmonary form being the main source of TB transmission. For the purposes of our work, individuals with pulmonary TB are ‘infectious’ and individuals with extrapulmonary TB are ‘non-infectious’ Note those in the ‘pulmonary’ category may have extra-pulmonary TB, but the reverse is not true
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