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Modelling the impact of increasing tuberculosis treatment coverage and addressing determinants of risk in men
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  • Published: 27 March 2026

Modelling the impact of increasing tuberculosis treatment coverage and addressing determinants of risk in men

  • Alexandra S. Richards  ORCID: orcid.org/0000-0001-9886-81041,2,
  • Mphatso D. Phiri  ORCID: orcid.org/0000-0002-4072-97153,4,
  • Jasper Nidoi  ORCID: orcid.org/0000-0002-1189-58614,5,
  • Jeremiah Chakaya6,7,
  • Peter MacPherson  ORCID: orcid.org/0000-0002-0329-96138,
  • Bruce J. Kirenga  ORCID: orcid.org/0000-0002-2023-28405,
  • John S. Bimba9,
  • Chukwuebuka Ugwu4,9,
  • Rhoda Pola  ORCID: orcid.org/0000-0002-6040-71237,
  • S. Bertel Squire10 &
  • …
  • Katherine C. Horton1,2 

Communications Medicine , Article number:  (2026) Cite this article

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We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Subjects

  • Epidemiology
  • Tuberculosis

Abstract

Background

Globally, the burden of tuberculosis falls more on men than women and children, and there are large gaps between men and women at all stages of exposure, disease incidence, and treatment. We examined the impact of addressing determinants of these gender gaps in Kenya, Malawi, Nigeria, and Uganda.

Methods

We created a deterministic transmission model of tuberculosis, calibrated to country-specific data on prevalence, incidence, mortality, and notifications between 2010 and 2022. We examined the potential epidemiological impact of strategies to increase treatment coverage among men and decrease the effects of social and structural determinants that increase men’s risk of developing TB. We investigated the impact (overall and by age and sex) on projected incidence and mortality in 2035, and notification rates between 2025 and 2030.

Results

Our modelling estimates that increasing treatment coverage among men could reduce incidence in 2035 between 2.4% [95% uncertainty interval (UI) 0.2-6.0%] in Malawi and 23.0% [UI 16.8-29.3%] in Nigeria. Reducing men’s excess risk of tuberculosis could similarly reduce incidence in 2035 between 9.8% [UI 7.5-12.6%] in Malawi and 30.1% [UI 24.1-40.5%] in Kenya. Impacts extend across the population with median estimates of country-level declines in incidence of between 0.9-17.8% and 1.4-22.2% in women and children, respectively, across the four countries.

Conclusions

Strategies that prioritise increasing tuberculosis treatment coverage among men and mitigating men’s higher susceptibility to tuberculosis could reduce disease burden for men, women, and children. Such gender-responsive strategies are essential to ensure a person-centred tuberculosis response and accelerate global progress towards the EndTB targets

Plain language summary

Globally, more men have tuberculosis than women or children, due to factors such as difficulty accessing care and increased exposure to risk factors such as high levels of alcohol consumption and tobacco smoking. We focussed on four countries, Kenya, Malawi, Nigeria, and Uganda, and built a mathematical model to understand the impact of increasing men’s access to diagnosis and treatment and the impact of reducing men’s exposure to risk factors. We found that strategies that focus on men not only reduce tuberculosis in men, but also across the entire population.

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Data availability

Data frames of all model outputs for this study are available at the GitHub repository https://github.com/alexandrasrichards/LIGHT_modelling within the Intervention results folders63. Data frames for outputs reported in this paper are available at the same GitHub repository within the Outputs folder63.

Code availability

All model development, calibration, and analyses were performed using R 4.5.039. Calibration used the hmer package (version 1.6.0), data analysis and visualisation used ggplot (3.5.2) and other packages within the tidyverse (version 2.0.0)37,64,65. The code used can be found in the GitHub repository https://github.com/alexandrasrichards/LIGHT_modelling63.

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Acknowledgements

ASR, MDP, JN, JC, PM, BJK, JSB, CU, RP, SBS, and KCH are supported by the UK Foreign, Commonwealth, and Development Office (Leaving No-one Behind Transforming Gendered Pathways to Health for Tuberculosis). KCH is also supported by the US National Institutes of Health (R-202309-71190). SBS is also supported by the Start4All programme, funded by Unitaid. The views expressed do not necessarily reflect the UK Government’s official policies. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Authors appreciate support from members of the national tuberculosis programmes in each of the countries in this analysis, including Wendy Nkirote, Aiban Ronoh, and Immaculate Kathure (National Tuberculosis, Leprosy, and Lung Disease Program, Kenya), Obioma Chijioke-Akaniro (National Tuberculosis, Leprosy and Buruli Ulcer Control Programme, Nigeria), Kuzani Mbendera, and Tisungane Mwenyenkulu (National Tuberculosis Control Programe, Malawi), and Stavia Turyahabwe (Ministry of Health, Uganda), Geofrey Amanya and Muzamiru Bamuloba (National Tuberculosis and Leprosy Program, Uganda) who shared their insights and understanding of TB epidemiology with the research team. Authors also appreciate support from Andy Iskauskas (University of Durham) and Nicky McCreesh (London School of Hygiene and Tropical Medicine) for their assistance in the calibration methodology. Authors also acknowledge support from management, research, research uptake, and programme management teams within The LIGHT Consortium.

Author information

Authors and Affiliations

  1. Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK

    Alexandra S. Richards & Katherine C. Horton

  2. TB Modelling Group, London School of Hygiene and Tropical Medicine, London, UK

    Alexandra S. Richards & Katherine C. Horton

  3. Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi

    Mphatso D. Phiri

  4. Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom of Great Britain and Northern Ireland

    Mphatso D. Phiri, Jasper Nidoi & Chukwuebuka Ugwu

  5. Research and Innovation, Makerere University Lung Institute, Kampala, Uganda

    Jasper Nidoi & Bruce J. Kirenga

  6. Department of Medicine, Dermatology and Therapeutics, Kenyatta University, Nairobi, Kenya

    Jeremiah Chakaya

  7. Public Health and Research Unit, Respiratory Society of Kenya, Nairobi, Kenya

    Jeremiah Chakaya & Rhoda Pola

  8. School of Health & Wellbeing, University of Glasgow, Glasgow, UK

    Peter MacPherson

  9. Zankli Research Centre, Bingham University, Karu, Nasarawa, Nigeria

    John S. Bimba & Chukwuebuka Ugwu

  10. Faculty of Clinical Sciences & International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK

    S. Bertel Squire

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Contributions

A.S.R, K.C.H., P.M., and S.B.S conceived the study. A.S.R ad K.C.H. designed the methodology and the software. K.C.H., J.C., P.M., J.S.B., B.J.K., and S.B.S. acquired the funding for the study, and K.C.H. and S.B.S. provided the resources and supervision. A.S.R. conducted the investigation, the formal analysis, data visualization and created the initial draft of the work. All authors validated the results and contributed to the review and editing of the final manuscript.

Corresponding author

Correspondence to Alexandra S. Richards.

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Communications Medicine thanks Jonathon R. Campbell and the other anonymous reviewer(s) for their contribution to the peer review of this work.

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Richards, A.S., Phiri, M.D., Nidoi, J. et al. Modelling the impact of increasing tuberculosis treatment coverage and addressing determinants of risk in men. Commun Med (2026). https://doi.org/10.1038/s43856-026-01536-3

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  • Received: 07 May 2025

  • Accepted: 09 March 2026

  • Published: 27 March 2026

  • DOI: https://doi.org/10.1038/s43856-026-01536-3

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