Spatial Spread of Tuberculosis through Neighborhoods Segregated by Socioeconomic Position: A Stochastic Automata Model

Abstract

Transmission of the agent of tuberculosis, Mycobacterium tuberculosis, is dependent on social context. A discrete spatial model representing neighborhoods segregated by levels of crowding and immunocompetence is constructed and used to evaluate prevention strategies, based on a number of assumptions about the spatial dynamics of tuberculosis. A cellular automata model is used to (a) construct neighborhoods of different densities, (b) model stochastically local interactions among individuals, and (c) model the spread of tuberculosis within and across neighborhoods over time. Since infected people may become progressively sick but also heal through treatment, the transition among stages was modeled with transition probabilities. A moderate level of successful treatment (40%) dramatically reduced the number of infections across all neighborhoods. Increasing the treatment in neighborhoods of a lower socioeconomic level from 40% to 90% results in an additional decrease of approximately 25% in the number of infected individuals overall. In conclusion, we find that a combination of a moderate level of successful treatment across all areas with more focused treatment efforts in lower socioeconomic areas resulted in the least number of infections over time.