Katherine Horton

@kchorton.bsky.social

540 Followers 356 Following

Infectious disease epidemiologist | Assistant Professor in #TB modelling @lshtm-tbmod.bsky.social @lshtm.bsky.social | Mama to 👦👦👦🐶

Incremental Cost-Effectiveness Ratios, with DALYs averted on x-axis and incremental budget (USD) on y-axis, for 3 countries. Error bars show 95% uncertainty intervals for DALYs averted (horizontal lines) and incremental budget (vertical lines). Dashed line shows cost-effectiveness thresholds. Vacc = Vaccination, TPT = Tuberculosis Preventive Treatment, Comm Scr = Community-wide screening (low diagnostic cost), Impr Diag = Improved diagnosis in clinics, DST for all = Drug Susceptibility Testing for all clinic-diagnosed individuals, Short DS = Shortened treatment for Drug Susceptible TB, Short DR = Shortened treatment for Drug Resistant TB, Pri Scr = Mass screening in incarcerated individuals, Nutr = Nutritional support for households of individuals receiving TB treatment.
Percentage of incident symptomatic TB episodes averted (2025-2050) for 9 interventions in 3 countries. Greatest impact for community screening, vaccination, and screening in prisons, followed by nutritional supplementation, improved diagnostics, and tuberculosis preventive treatment. Vacc = Vaccination, TPT = Tuberculosis Preventive Treatment, Comm Scr = Community-wide screening, Impr Diag = Improved diagnosis in clinics, DST for all = Drug Susceptibility Testing for all clinic-diagnosed individuals, Short DS = Shortened treatment for Drug Susceptible TB, Short DR = Shortened treatment for Drug Resistant TB, Pri Scr = Mass screening in incarcerated individuals, Nutr = Nutritional support for households of individuals receiving TB treatment. BRA = Brazil, IND = India, ZAF = South Africa. Error bars reflect 95% Uncertainty Intervals.
Epidemiological model structure and subdivisions. Model structure for the natural history of TB, incorporating both general subdivisions and country-specific structural determinants: incarceration (Brazil), undernutrition (India), and HIV (South Africa). Background mortality is assumed for all states but not shown; arrows exiting from the corners of certain states represent specific mortality rates. The model is age-stratified in 5-year bands up to 75+ years. TB states shaded in light grey represent individuals harbouring viable Mycobacterium tuberculosis and are further subdivided by drug resistance; this also applies to those recently treated, assuming relapse would involve the same strain. Dark grey TB states appear only in the previously treated stratum within the treatment subdivisions.
Projected incidence of symptomatic TB (sTB) (top) and TB mortality (bottom) for maximum population coverage (100%) and duration of screening (5 years) for diagnostic algorithms targeting sTB (Cough+Xpert), infectious TB (Xpert), and all TB (CXR) in a population with baseline prevalence of 500 per 100,000. Horizontal dashed lines show median reduction in incidence or mortality at the end of screening for each algorithm. Vertical arrows indicate median rebound in incidence or mortality in the five years following the end of screening for each algorithm.
Number of true positive results, false positive results, and false positive results per true positive result for each round of screening (up to five rounds) by diagnostic algorithm and population coverage. sTB: symptomatic infectious TB; Cough+Xpert: prolonged cough with confirmatory GeneXpert Ultra; Xpert: GeneXpert Ultra; CXR: chest X-ray.
Projected reductions in symptomatic TB incidence 10 years after the start of screening by diagnostic algorithm, population coverage, and duration in a population with baseline prevalence of 500 per 100,000 population.
Figure 1. Estimated number of trial endpoints in the control group of a prevention-of-disease vaccine trial in a high disease-burden setting showing number of endpoints on the y-axis and time in months on the x-axis. For bacteriologically confirmed symptomatic tuberculosis disease endpoints only, we estimate 69 endpoints, and for combined bacteriologically confirmed asymptomatic and symptomatic tuberculosis disease endpoints, we estimate 151 endpoints. Scenario assumes symptomatic disease incidence before trial screening of 300/100 000 per year and following 10 000 individuals over 3 years. Prevalent symptomatic and asymptomatic tuberculosis disease are screened out in month 0 and are not trial endpoints. Active screening occurs every 6 months for both scenarios and participants self-presenting with symptoms suggestive of tuberculosis disease would also be investigated.
The figure shows two graphs, both with age on the x-axis and separate curves for males and females. In the top figure, the y-axis shows prevalence of Mtb immunoreactivity; in the bottom figure, the y-axis shows annual risk of Mtb conversion. In both figures, the curves for males and females diverge from adolescence and remain higher for men than women through adulthood.
Global map with countries coloured to show funding received and inclusion in analyses: grey indicates countries included in analysis that did not receive funding from USAID or Global Fund; green indicates included countries that receive Global Fund support for TB; orange indicates included countries that receive USAID and Global Fund support for TB. Also shown are countries that receive funding but were not modelled (green stripes for Global Fund; orange stripes for USAID and Global Fund.
Table showing excess symptomatic TB episodes and excess TB deaths expected for different funding scenarios, including termination of USAID funding and reductions in Global Fund funding in line with expected reductions in donor countries' overseas development assistance.
Line chart showing median number of TB deaths in 79 low- and middle-income countries from 2010 through 2040. A black line shows a decline from 1.25 million deaths in 2010 to just under 1 million deaths in 2024. A blue line shows the number of deaths staying constant through 2040 if 2024 funding and programmes are maintained. A red line shows the number of deaths increasing to 1.2 million in 2040 if US funding to national TB programmes is terminated.
Colourful stickers that say "Mamas don't let your babies grow up to be misogynists" and "We won't turn back" sitting on a colourful tea towel that says "Better south, better world"