Combination interventions to control the tuberculosis epidemic in the Karamoja subregion of Uganda: A modelling analysis

The Karamoja subregion in northeastern Uganda is disproportionately affected by tuberculosis (TB), with an estimated TB prevalence >3 times the national average. Recently introduced health systems strengthening (HSS) interventions, including active symptom screening campaigns covering approximately 20% of the population annually, have substantially increased the number of people initiated on TB treatment, improved TB treatment completion and increased uptake of TB preventive therapy. However, to achieve further reductions in TB incidence and mortality, additional interventions are needed. We aimed to assess the impact of four additional interventions, layered onto existing HSS interventions, on TB incidence and mortality. We developed a dynamic compartmental model calibrated to TB epidemiology in Karamoja (population 1.4 million, 50% children