Title
Linking individual natural history to population outcomes in tuberculosis
Date Issued
01 January 2018
Access level
open access
Resource Type
research article
Publisher(s)
Oxford University Press
Abstract
Background. Substantial individual heterogeneity exists in the clinical manifestations and duration of active tuberculosis. We sought to link the individual-level characteristics of tuberculosis disease to observed population-level outcomes. Methods. We developed an individual-based, stochastic model of tuberculosis disease in a hypothetical cohort of patients with smear-positive tuberculosis. We conceptualized the disease process as consisting of 2 states-progression and recovery-including transitions between the 2. We then used a Bayesian process to calibrate the model to clinical data from the prechemotherapy era, thus identifying the rates of progression and recovery (and probabilities of transition) consistent with observed population-level clinical outcomes. Results. Observed outcomes are consistent with slow rates of disease progression (median doubling time: 84 days, 95% uncertainty range 62-104) and a low, but nonzero, probability of transition from disease progression to recovery (median 16% per year, 95% uncertainty range 11%-21%). Other individual-level dynamics were less influential in determining observed outcomes. Conclusions. This simplifed model identifes individual-level dynamics-including a long doubling time and low probability of immune recovery-that recapitulate population-level clinical outcomes of untreated tuberculosis patients. This framework may facilitate better understanding of the population-level impact of interventions acting at the individual host level.
Start page
112
End page
121
Volume
217
Issue
1
Language
English
OCDE Knowledge area
Enfermedades infecciosas
Scopus EID
2-s2.0-85044076651
PubMed ID
Source
Journal of Infectious Diseases
ISSN of the container
00221899
Sources of information: Directorio de Producción Científica Scopus