Exploring the epidemiological impact of universal access to rapid tuberculosis diagnosis using agent-based simulation

Parastu Kasaie, Hojoon Sohn, Emily Kendall, Gabriela B. Gomez, Anna Vassall, Madhukar Pai, David W. Dowdy

Research output: Chapter in Book/Report/Conference proceedingConference contribution

1 Scopus citations


Many high-burden countries have committed to providing universal access to rapid diagnosis of tuberculosis (TB), but the corresponding impact on population-wide incidence is unknown. We designed an agent-based simulation of drug-susceptible (DS) and drug-resistant (DR) TB in a representative Indian setting and compared the impact of Xpert testing via a decentralized (Xpert available at each local-population) versus centralized (Xpert available at the district-level serving multiple local-populations) strategy. Decentralized testing resulted in a 36% reduction in DR-TB incidence at 10 years compared to no Xpert. Depending on assumptions regarding pre-treatment loss to follow-up (ranging from 5 to 50%), the impact of centralized testing ranged from a 35% to 22% reduction in DR-TB incidence. Implementation of Xpert by either approach had a negligible impact (<5%) on DS-TB incidence. Decisions regarding choice of centralized vs. decentralized Xpert will heavily depend on operational aspects of centralized Xpert and loss to follow-up.

Original languageEnglish (US)
Title of host publication2017 Winter Simulation Conference, WSC 2017
PublisherInstitute of Electrical and Electronics Engineers Inc.
Number of pages12
VolumePart F134102
ISBN (Electronic)9781538634288
StatePublished - Jan 4 2018
Event2017 Winter Simulation Conference, WSC 2017 - Las Vegas, United States
Duration: Dec 3 2017Dec 6 2017


Other2017 Winter Simulation Conference, WSC 2017
Country/TerritoryUnited States
CityLas Vegas

ASJC Scopus subject areas

  • Software
  • Modeling and Simulation
  • Computer Science Applications


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