Investigating household interventions for controlling Tuberculosis using discrete event simulation

Abstract

Current control methods for Tuberculosis (TB) disease have failed to keep pace with the TB epidemics which have been particularly affected by the Human Immunodeficiency Virus (HIV) epidemic.  There is still relatively little known about the interactions between HIV and TB and therefore TB control strategies that are effective in high HIV prevalent settings still need to be identified.  The current policy is the active case-finding for adults living in endemic TB settings is ineffective, because transmission events between casual contacts greatly outnumber household transmission events.  This policy was developed in an era of low HIV prevalence and the impact of the HIV epidemic on the relative importance of household versus community transmission has not been fully assessed.

The majority of mathematical models used to describe the epidemiology of TB and investigate methods of control have been deterministic compartmental models that have considered only homogeneous mixing.  This thesis describes a discrete event simulation model that includes the effect of household structure on the transmission dynamics of TB. It is used to evaluate the effectiveness of targeted case-finding interventions in controlling TB in HIV prevalent populations.

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