Modelling the social and structural determinants of TB: opportunities and challenges

Introduction Despite the close link between tuberculosis (TB) and poverty, most mathematical models of TB have not addressed underlying social and structural determinants (SD). In this paper, we review studies employing mathematical modelling to evaluate the epidemiological impact of SD of TB. Methods We systematically searched PubMed and personal libraries to identify eligible papers. We extracted data on modelling techniques employed, research question, type of SDs modelled, and setting. Results From 232 records identified, we included eight papers published between 2008 and 2015; six employed population-based dynamic TB transmission models and two non-dynamic analytic models. Seven studies focused on proximal TB determinants (four on nutritional status, one on wealth, one on indoor air pollution, and one examined overcrowding, socioeconomic and nutritional status), and one focused on macroeconomic influences. Conclusions Few modelling studies have attempted to evaluate SD of TB, resulting in key knowledge gaps. Despite challenges of modelling such a complex system, models must broaden their scope to remain useful for policy making. Given the inter-sectoral nature of the interrelations between SD and TB outcomes, this work will require multi-disciplinary collaborations. A useful starting point would be to focus on developing relatively simple models that can strengthen our knowledge regarding the potential effect of SD on TB outcomes.