Capturing heterogeneous infectiousness in transmission dynamic models of tuberculosis: a compartmental modelling approach

Abstract Infectiousness heterogeneity among individuals with tuberculosis (TB) is substantial and is likely to have a significant impact on the long-term dynamics of TB and the effectiveness of interventions. However, there is a gap in capturing heterogeneous infectiousness and evaluating its impact on the effectiveness of interventions. Informed by observed distribution of secondary infections, we constructed a deterministic model of TB transmission using ordinary differential equations. The model incorporated assumption of heterogeneous infectiousness with three levels of infectivity, namely non-spreaders, low-spreaders and super-spreaders. We evaluated the effectiveness of dynamic transmission untargeted and targeted implementation of an intervention intended to represent active case finding with a point-of-care diagnostic tool. The simulated intervention detected 20% of all TB patients who would otherwise have been missed by the health system during their disease episode and was compared across four epidemiological scenarios. Our model suggested that targeting the active case finding intervention towards super-spreaders was more effective than untargeted intervention in all setting scenarios, with more effectiveness in settings with low case detection and high transmission intensity. For instance, a targeted intervention achieved a 42.2% reduction in TB incidence, while the untargeted intervention achieved only a 20.7% reduction over 20 years, given the same number of people treated. Although the most marked impact on equilibrium TB incidence came from the rate of late reactivation, the proportion of super-spreaders and their relative infectiousness had shown substantial impact. Targeting active case-finding interventions to highly infectious cases likely to be particularly beneficial in settings where case detection is poor. Heterogeneity-related parameters had an equivalent effect to several other parameters that have been established as being very important to TB transmission dynamics.