Country-level TB model catalogue DRAFTThe following document is a catalogue and characterisation of models currently able to provide all of the following:
● country-level estimates of TB
● the health impact of competing policy alternatives for TB control
● guidance on optimal resource allocation or the exploration of incremental cost-effectiveness

Currently this consist of 6 models and associated modelling teams. In alphabetical order, these are AuTuMN, EMOD, Optima TB, SEARO, TIME and VI. We welcome the addition of any models not listed that can provide the above. Please note that the catalogue is not intended as either an endorsement or a critique of the models involved, but rather as an aid to demonstrate the features and functioning of the models and modelling teams. The target audience of this catalogue are participants and stakeholders in country-level TB modelling effort. This includes, but is not limited to, modellers who build and/or apply models, policy makers, technical experts, and other members of the TB community in high TB burden countries and international funding and technical partners.

An outline introducing each model and how to contact the modelling team is provided below. The model catalogue consists of a set of eight tabs (see below) characterising separate features of each model. These include both the underlying epidemiological and cost models, the policy options that the model is able to represent, how the model develops an optimal portfolio, the approach of the modelling team to technical assistance, a previous history of model applications and some of the major limitations of the model. Each tab is separated into separate sections describing different aspects of the feature the tab outlines. A list of answers to questions pertinent to each section has been provided by each modelling team. For additional details regarding a particular question or answer, hover the cursor over the cell. Links may be available for some questions and answers.

Compiled and maintained at the request of TB MAC stakeholders by the TB MAC committee, with thanks to the modelling teams. Please contact for further details.
Introduction to the model
The AuTuMN team is a group with diverse backgrounds and skills, including TB doctors, public health physicians, epidemiologists, mathematician, health economist, and so on. The aim is to provide a tool for decision support for National Tuberculosis control programs.

Our activity starts with a detailed analysis of health systems, political scenarios, TB control program baseline activity, planned changes to TB control activities and epidemiology.
We have developed the AuTuMN software platform for country-level applications to help national programs better understand their TB epidemic, to predict future trends based on current epidemiology and programmatic responses, to estimate the likely impact resulting from future changes to the programmatic response, to perform cost and cost-effectiveness analyses, and to optimise allocation of resources.

AuTuMN comprises seven different modules for disease dynamics, health economics, automatic calibration, uncertainty analysis, data inputs, model outputs and graphical visualisation. These modules are linked to one another through a user-friendly graphical user interface (GUI)
The Institute for Disease Modelings’s epidemiological modeling software (EMOD) for TB provides a customizable framework to explore the impact of public health interventions, changing population demographics (including movement patterns), and underlying individual dynamics of TB epidemiology (including TB-HIV co-infection and individual-level variability).

The EMOD TB framework allows straightforward specification of detailed cascades of care which explicitly incorporate passive, intensified and active case finding; diagnostic algorithms; preventative therapy; TB treatment; HIV testing and provision of ART; as well as integration of HIV and TB services. The model may be used to specify a wide range of interventions such as drug therapies (including MDR evolution and dynamics), behavioural interventions, and vaccines.

EMOD TB is an individual based, stochastic, dynamic model of TB transmission and TB/HIV pathogenesis. It is available as a single pre-built binary for Windows and CentOS7.1 for Azure environments. Source code is implemented in C++ and is made available through the Creative Commons Attribution-Noncommercial-ShareAlike 4.0 License.
The SEAR model was developed as a collaboration between the WHO South-East Asian Regional Office (SEARO), the Public Health Foundation of India, and Imperial College London. The principal purpose of the model is to inform TB control priorities for the 11 countries of the South East Asian Region, to meet the 2035 End TB goals. It is a compartmental, deterministic framework, fully integrated with a cost component for estimating resource needs. The model incorporates public and private healthcare sectors; the acquisition and transmission of drug resistance; HIV/TB coinfection; and vulnerable populations. It is calibrated independently to each of the SEAR countries, and uses Bayesian techniques to estimate uncertainty in model outputs.The TIME user-friendly modelling suite has been developed by the London School of Hygiene and Tropical Medicine in collaboration with Avenir Health to help improve TB care and prevention in low- and middle-income countries by strengthening policy discussions and enabling local capacity building.

TIME modules can inform discussions around the epidemiological impact, budget and resource implications, and cost-effectiveness of different intervention policies. Crucially, the software, technical documentation and user manuals are also freely accessible (see downloads section on website). In combination with tested capacity building pathways, these materials enable countries to apply TIME with increasing independence.

Our vision of country engagement is one of long-term collaboration. By building up experience and capacity over the course of repeated applications of TIME modules to inform TB policy questions, the work is increasingly led by trained in-country individuals. Through this process, TIME becomes a transparent and powerful tool to strengthen decision making.

TIME has been widely applied in the past years, successfully informing decisions on TB investment cases and NSPs, as well as a number of GFATM funding requests. In parallel, our capacity building efforts have led to multiple countries leading on their own applications of TIME.
Who should be contacted if a country is interested in applying the model?Emma McBryde, James Cook UniversityBradley Wagner, The Institute for Disease ModellingAnna Roberts, The Burnet InstituteNimalan Arinaminpathy, Imperial College LondonRein Houben, London School of Hygiene and Tropical MedicineIvor Langley, Liverpool School of Tropical Medicine
Link to model website
When was the model catalogue last updated?