Our research covers a wide variety of tuberculosis topics in countries around the world. You can view a full list of our projects below or use the following links to view projects by topic:

Policy and Planning Tools – Capacity Building – Trials

Vaccines – Treatment – Drug Resistance – Latent TB Infection

TB-HIV – Social Determinants – Risk Groups

Immunology – Molecular Epidemiology – Bovine TB – Natural History

TB Modelling and Analysis Consortium (TB MAC)

Aims: Improve global TB control by coordinating and promoting mathematical modelling and other quant research relevant to support evidence-based policy making and implementation; Identify high priority research questions that require modelling; Achieve consensus on current knowledge and knowledge gaps, methodological standards, and best practice for TB control decision making; Fund analytical/modelling projects; Disseminate results and tools

People: Richard White (Director and Chair), Finn McQuaid, Anna Vassall, Ted Cohen (Yale), David Dowdy (JHU), Philip Eckhoff (IDM), Michael Kimerling (KNCV), Geoff Garnett (BMGF), Damian Walker (BMGF)

Funding: Bill and Melinda Gates Foundation

TIME support grant – application to inform TB policy decision making and build capacity in LMICs

Aims: (i) To inform TB policy decision-making at the national and sub-national level by applying a comprehensive and accessible modelling framework. (ii) To enable local capacity building and ownership through training and support.

The TIME ( model has been applied >15 countries, 5 of which have local capacity to operate the model with only limited external support. This grant supports the continued development of the TIME modelling suite, and its application in LMIC.

People: Rein Houben, Marek Lalli, Debora Pedrazzoli, Nabila Shaikh, Jamie Rudman, Kristian Godfrey, Carel Pretorius (Avenir Health), Matt Hamilton (Avenir Health), Richard White

Funding: Global Fund to Fight AIDS, Tuberculosis and Malaria

Infection prevention and control for drug-resistant tuberculosis in South Africa in the era of decentralised care: a whole systems approach

Aims: This project employs an interdisciplinary whole systems approach to examine the social, biological and infrastructural dynamics of nosocomial transmission of drug-resistant tuberculosis (DR-TB) in two provinces in South Africa, with the aim to inform health systems interventions for improving infection control for DR-TB.

People: Alison Grant, Janet Seeley, Karina Kielmann, Christopher Colvin, Hayley MacGregor, Richard Lessells, Anna Vassall, Richard White, Rein Houben, Anna Voce, Nicky McCreesh, Tom Yates, Alexander Pym

Funding: ESRC

TB or not TB: What is Tuberculosis? Challenging the Current Paradigm of Tuberculosis Natural History using Mathematical Modelling Techniques

TB or not TB website

Aims: TBornotTB is a project that aims to better understand how tuberculosis (TB) develops in individuals and spreads in populations. For a public health threat that has caused over two billion deaths in human history the so-called natural history of TB has remained stubbornly elusive. The classic paradigm of TB natural history typically accounts for two distinct stages of infection and disease, and one-way progression between them. However, data has shown that individuals can actually experience disease across a spectrum intensity, which varies over time.

Before the TBornotTB project, little was known on how many individuals are currently in the different stages of disease, how long they remain there, and how much they contribute to ongoing transmission. If we however better understand the reality of TB in a population, the limited resources available can be used more effectively to reduce the burden of disease, thus saving lives now, and reducing transmission in the future. That is why TBornotTB has two main objectives. First to bring together old and new data to understand how the new states of TB infection and disease are. Second to use mathematical modelling tools to show the consequences, which should help improve TB policies.

People: Rein Houben, Jon Emery, Alexandra Richards, Katherine Horton, Nabila Shaikh, and Nicola Foster

Funding: TBornotTB has received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (Starting Grant, Grant agreement No. 757699)

Determining the importance of different locations to Mycobacterium tuberculosis transmission in high tuberculosis burden settings

Aims: Estimate the proportion of M.tb. transmission that occurs in different locations in Cape Town and other high incidence, sub-Saharan African settings, and investigate the implications for TB control

People: Nicky McCreesh, Richard White, Keren Middelkoop, (University of Cape Town), Robin Wood (University of Cape Town), Peter Godfrey-Faussett, Arminder Deol

Funding: Medical Research Council

Validation of Correlates of Risk of TB Disease in High Risk Populations

Aims: To validate diagnostic and prognostic performance of a blood RNA signature of risk for tuberculosis (TB) in HIV infected persons and to model the population level impact.

People: Mark Hatherill (UCT), Tom Sumner, Gavin Churchyard (Aurum), Richard White, and colleagues

Funding: Bill and Melinda Gates Foundation

Latent TB

Aims: Better understand the size of the population with a Latent TB Infection (LTBI), both in the UK and globally; Explore the potential of existing drugs to cure LTBI in individuals, and how this differs by HIV infection status and use of Antiretroviral Therapy; Model the population impact and cost-effectiveness of novel strategies to identify and treat LTBI so as to contribute to TB control in the population

People: Rein Houben, Tom Sumner, Emilia Vynnycky, Richard White, Finn McQuaid, Gwen Knight and Pete Dodd.

Funding: none

Data utilisation and modelling to support TB control policy and practice in South Africa

Aims: Create a sustainable system to integrate quantitative analysis into TB control policy and implementation decision making in South Africa

People: Richard White, Tom Sumner, Rein Houben, Carel Pretorius (Avenir Health), Gavin Churchyard (Aurum), Salome Charalambous (Aurum), Piotr Hippner (Aurum), Don Mudzengi (Aurum), Philip Eckhoff (IDM), Brad Wagner (IDM), Stuart Chang (IDM), David Collier, Fiammetta Maria Bozzani, Anna Vassall

Funding: Bill and Melinda Gates Foundation

A clinical trial of a correlate of risk targeted screen and treat strategy to impact TB control

Aims: Carry out a clinical trial and modelling of a correlate of risk targeted screen and treat strategy to impact TB control

People: Mark Hatherill (UCT), Tom Sumner, Gavin Churchyard (Aurum), Richard White, and colleagues

Funding: Bill and Melinda Gates Foundation

Stimulating and shaping the market for HIV self-testing in Africa: two-tier demonstration and evaluation of accuracy and linkage in 4 countries.

Aims: Stimulate and shape the market for HIV self-testing in Africa using data collection and modelling

People: Liz Corbett, Tom Sumner, Rein Houben, Andrew Philips (UCL), Richard White, and colleagues

Funding: UNITAID

Understanding the transmission of tuberculosis using Mycobacterium tuberculosis sequence data

Aims: Help understand the transmission of tuberculosis using Mycobacterium tuberculosis sequence data

People: Tanne Clark, Judith Glynn, Richard White, Mia Crampin, Gwen Knight (Imperial), and colleagues

Funding: Medical Research Council

Controlling TB through action on its social and structural determinants: a modelling approach

Aims: Provide evidence on the impact of socio-economic determinants on TB control using mathematical modelling

People: Debora Pedrazzoli, Delia Boccia, Rein Houben, Richard White

Funding: Wellcome Trust, USAID, TB MAC

Nationwide patient cost survey in Ghana

Aims: To assess the financial burden of TB related costs on TB affected households in Ghana in collaboration with the Dodowa Health Research Centre and the Ghana National Tuberculosis Programme

People: Debora Pedrazzoli, Rein Houben, Delia Boccia, Samia Laokri, Knut Lönnroth, Andrew Siroka, Jo Borghi

Funding: USAID

Impact of a conditional cash transfer programme on HIV/AIDS and tuberculosis in Brazil and forecast of effectiveness scenarios

Aims: Estimate the impact of a conditional cash transfer programme on HIV/AIDS and tuberculosis in Brazil and forecast of effectiveness scenarios

People: Davide Rasella (Wellcome Trust), Rein Houben, Laura Rodrigues, Richard White, and colleagues

Funding: Wellcome Trust

Optimising contact tracing in London

Aims: Develop mathematical modelling approaches to help optimise TB contact tracing in London

People: Sean Cavany, Emilia Vynnycky, Tom Sumner, Richard White, Lucy Thomas (PHE), Charlotte Anderson (PHE), Helen Maguire (PHE)

Funding: Public Health England

Potential impact of age-targeted future TB vaccines in settings with aging populations or high HIV prevalence

Aims: Estimate the epidemiological impact of age targeted future TB vaccines in a high TB burden, low-HIV prevalence setting undergoing population ageing (China); Estimate the epidemiological impact of future TB vaccines in a high TB burden setting with high HIV prevalence; Model outcomes can be used to prioritise development of vaccine candidates with greatest potential public health impact.

People: Rebecca Harris, Tom Sumner, Gwen Knight (Imperial), Richard White, and colleagues

Funding: Aeras, Medical Research Council

Spatial mapping of TB cases in low income settings without residential addresses

Aims: Development and evaluation of a low-cost, easy to use, electronic tool embedded in the National Tuberculosis Programme to capture the place of residence of TB patients registering for TB treatment in Blantyre, Malawi; Spatial data generated can be used for identification of disease hotspots, tracing patients lost to follow up and identifying cluster membership in ongoing interventional studies in the area.

People: Rebecca Harris, Liz Corbett, Augu Choko, Richard White, and colleagues

Funding: Medical Research Council, Wellcome Trust

Gender differences in TB burden and access to care

Aims: Understand how gender differences in the TB risk and access to care contribute to the excess male burden in prevalence and case notifications; Explore the potential impact and cost-effectiveness of interventions targeting men to improve access to diagnostic and/or treatment services and reduce gender inequity

People: Katherine Horton, Liz Corbett, Rein Houben, Richard White, Peter MacPherson (Liverpool), Roel Bakker

Funding: none

Modelling the transmission of mycobacterial infections in wild and domestic animal and human populations in Uganda

Aims: Use modelling to help understand the transmission dynamics of mycobacterial infections in wild and domestic animal populations at the wildlife-livestock interface in western Uganda

People: Natascha Meunier, Richard Kock (RVC), Richard White

Funding: Bloomsbury Colleges

Modelling to accelerate TB vaccine candidate selection

Aims: Develop a framework in which mathematical models are used to better understand human and animal immune response to TB vaccination using available immunological data from the IC31 adjuvanted protein vaccine; Predict the best dose of the vaccine in terms of immunogenicity in humans based on varying dose-response data in animals

People: Sophie Rhodes, Tom Evans (Aeras), Steven Kern (BMGF), Gwen Knight (Imperial), Richard White, Helen Fletcher

Funding: Aeras

Empirical H56 TB vaccine dose ranging on mouse immunogenicity to inform mathematical modelling

Aims: Collect empirical data on H56 TB vaccine dose ranging on mouse immunogenicity to inform mathematical modelling

People: Sophie Rhodes, Tom Evans (Aeras), Steven Kern (BMGF), Gwen Knight (Imperial), Richard White, Helen Fletcher, and colleagues

Funding: Bill and Melinda Gates Foundation

Interpreting the impact of mass community-wide isoniazid preventive treatment in Bethel, Alaska

Aims: Understand the reasons for the observed impact of preventive treatment in a high incidence setting in Alaska

People: Rein Houben, Emilia Vynnycky

Funding: none

Improving scientific and public health decision making by developing technologies to increase use of robust methods to calibrate and analyse complex mathematical models

Aims: Complex mathematical models are increasingly being used for research and decision making in academia, health and industry. However, the robust calibration and analysis of computationally intensive models is infeasible using currently accessible technologies, which limits the amount of information that can be extracted to inform decision making. Methods exist for calibrating these models (history matching with model emulation), but their use currently requires extensive, specialised statistical support. We will fill this technology gap by converting these specialist technologies into a comprehensive software package in R, accompanied by a series of ‘case studies’ demonstrating how these methods can be used by the academic, industry and health decision making communities.

People: Richard White, Nicky McCreesh, Ian Vernon (Durham), Michael Goldstein (Durham), TJ McKinley (Exeter)

Funding: Wellcome Trust

Defining drivers of TB transmission in the era of universal ART, and implications for finding the walking well

Aims: HIV-positive people are assumed to be less infectious than HIV-negative people, based on pre-antiretroviral therapy (ART) era data. ART-driven immune restoration prolongs survival and may increase individual infectiousness, but the extent to which HIV-positive people taking ART contribute to TB transmission in the “treat all” era is unknown. Population-based TB prevalence surveys consistently find that about half of people with Mycobacterium tuberculosis in sputum do not report symptoms; the contribution of the asymptomatic “walking well” to TB transmission is also unknown. Our project addresses these key gaps in knowledge, using the proportion of child household contacts with TB infection to determine the effect of ART and of symptoms on the infectiousness of index TB patients. These data will inform mathematical and economic models to project the circumstances under which symptom-agnostic screening is likely to be cost-effective.

People: Alison Grant, Katherine Fielding, Richard White, Anna Vassall, Rein Houben, Nicky McCreesh

Funding: NIH

Adherence Support Coalition to End TB (ASCENT)

Aims: To generate evidence on integrated digital adherence technology interventions in five key countries (Ethiopia, the Philippines, South Africa, Tanzania, and Ukraine). Implementation research will focus on understanding the effectiveness, acceptability and feasibility of the proposed intervention. Cost-effectiveness of the intervention compared to standard of care will be evaluated, including an estimate of patient costs, and the potential impact of the intervention calculated using mathematical models.

People: Finn McQuaid, Katherine Fielding, Matt Quaife, Rein Houben, Richard White, Kristian van Kalmthout (KNCV), Job van Rest (KNCV), Jens Levy (KNCV), Salome Charalambous (Aurum), Alexsey Bogdanov (PATH), Kristian Godfrey

Funding: Unitaid

Closed projects

Methods for allocative efficiency of the Global Fund TB, HIV and malaria country grants

Aims: Develop country-specific TB and TB/HIV models to evaluate TIME and quantify burden, costs and potential impact of the national strategic plans and/or to input into GFATM concept notes; Develop materials for TIME train-the-trainer workshops; Run train-the-facilitator workshops to develop a cadre of trainers capable of applying TIME version 1 in the 22 high burden countries; Develop TIME version 2

People: Rein Houben, Marek Lalli, Debora Pedrazzoli, Carel Pretorius (Avenir Health), Sevim Ahmedov (USAID), Cheri Vincent (USAID), Richard White

Funding: USAID

Interpreting the outcome of the trial of mass community-wide preventive therapy in a high incidence setting in South Africa (Thibela TB)

Aims: Understand the reasons for the observed impact of mass community wide preventive treatment in a high incidence setting in South Africa

People: Richard White (PI on CREATE modelling core), Emilia Vynnycky, Tom Sumner, Alison Grant, Katherine Fielding, James Lewis, Andy Cox, Gavin Churchyard (Aurum Institute), Richard Hayes, Liz Corbett

Funding: Bill and Melinda Gates Foundation

Using modelling and molecular data to estimate the extent of ongoing transmission and the epidemiology of TB in the West Midlands

Aim: Use modelling and molecular data to estimate the extent of ongoing transmission in the West Midlands

People: Adrienne Keen, Jason Evans (Birmingham), Judith Glynn, Ibrahim Abubakar (UCL, PHE), Grace Smith (Birmingham), Richard White, Emilia Vynnycky

Funding: none

Consortium to respond effectively to the AIDS/TB epidemic (CREATE)

Aims: Reduce death and disease from TB in populations with high rates of HIV AIDS; 4 interventions: Zamstar: HH & ECF, Thibela TB: Mass IPT, DetecTB: ACF; Develop models that fit baseline populations; Gather data on key unknowns; Provide timely modelling, projection, and better understanding of trial results; Project longer term impact and alternative strategies

People: Liz Corbett, Richard White, Emilia Vynnycky, Richard Hayes, Dick Chaisson (JHU), Tom Sumner, Emilia Vynnycky, Pete Dodd (Sheffield)

Funding: Bill and Melinda Gates Foundation

Impact of IPT and ART on TB in South Africa

Aims: Provide evidence for policy making on how best to use IPT and ART to control TB in South Africa using mathematical modelling; Use empirical data to create model scenarios representing the diversity of TB/HIV epidemics in South Africa; Simulate range of scenarios of IPT and ART targeting and scale-up to estimate impact on MTB transmission and TB disease incidence; Provide setting-specific policy recommendations

People: Richard White, Emilia Vynnycky, Rein Houben, Katherine Fielding, Alison Grant, Taraz Samandari (CDC), Tom Sumner, Gwen Knight, Pete Dodd (Sheffield)

Funding: CDC/PEPFAR via Aurum Institute

Potential global cost-effectiveness of future TB vaccines

Aims: To evaluate the potential cost-effectiveness of future tuberculosis vaccines

People: Gwen Knight, Richard White, Ulla Griffiths, Anna Vassall

Funding: Aeras

Estimating the impact of the national strain-typing service in England

Aim: Assess the effectiveness and cost-effectiveness of the strain-typing service in England

People: Emilia Vynnycky, UK TB Strain Typing Evaluation Group

Funding: none

TB natural history and drug susceptibility algorithms

Aims: Investigate aspects of natural history that are important for drug susceptibility algorithms

People: Gwen Knight, Richard White, David Dowdy (JHSPH), Ted Cohen (Harvard)

Funding: Bill and Melinda Gates Foundation

Pre-resistance mutations in Mycobacterium tuberculosis

Aims: Investigate the importance of pre-resistance mutations in M.tb.

People: Adedeji Majekodunmi (UCL), Gwen Knight, Tim McHugh, Joana Foncesca

Funding: none

VALUE-TB: Cost-effectiveness of two new shortened (4-MONTH) regimens (REMox)

Aims: Evaluate the cost-effectiveness of replacing standard regimens with a shortened REMox regimen that contain moxifloxacin instead of ethambutol or isoniazid

People: Anna Vassall, Gwen Knight, Richard White, Pete Dodd (Sheffield), Frank Cobelens (AIGHD), David Dowdy (JHSPH)

Funding: TB Alliance

Modelling impact for novel TB drug regimens

Aims: Investigate the impact and cost-effectiveness of difference drug susceptibility algorithms for new drug TB regimens

People: Gwen Knight, Richard White, David Dowdy (JHSPH), Ted Cohen (Harvard)

Funding: Bill and Melinda Gates Foundation

Mathematical modelling and spatial data analysis to inform TB care and control strategies in high TB incidence settings

Aim: Determine how spatial data from TB cases presenting at clinics can best be used to improve the impact and cost-effectiveness of TB care and control interventions in high incidence settings

People: Nicky McCreesh, Richard White, Liz Corbett, Peter Diggle (Lancaster), Mia Crampin, Helen Ayles, Nulda Beyers (Stellenbosch), Judith Glynn, David Dowdy (John Hopkins), Peter Godfrey-Faussett

Funding: Medical Research Council

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