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2026-27 Project (Horton & Houben)

Epidemiological impact of heterogeneity in community screening for tuberculosis

SUPERVISORY TEAM

Supervisor

Dr Katherine Horton at LSHTM
Faculty of Epidemiology & Population Health, Department of Infectious Disease Epidemiology and Dynamics
Email: katherine.horton@lshtm.ac.uk

Co-Supervisor

Professor Rein Houben at LSHTM
Faculty of Epidemiology & Population Health, Department of Infectious Disease Epidemiology and Dynamics
Email: rein.houben@lshtm.ac.uk

PROJECT SUMMARY

Project Summary

Community screening for tuberculosis offers an opportunity to interrupt transmission and accelerate progress towards end TB targets. However, disease burden is inequitably distributed across population groups (by, e.g., age, sex, location), and heterogeneity in the coverage of community screening approaches across these groups has not been explored. This project will use systematic data synthesis and mathematical modelling to quantify how heterogeneity in screening coverage across specific population groups – in particular, underrepresentation of groups with higher rates of disease – affects the epidemiological impact of screening approaches. Translating these insights across settings, where the balance between heterogeneity in coverage and inequities in disease burden may differ, will directly inform local policy decisions on effective, equitable, and locally relevant screening approaches.

Project Key Words

Tuberculosis, community, heterogeneity, policy, modelling

MRC LID Themes

  1. Infectious Disease
  2. Global Health

Skills

MRC Core Skills

  1. Quantitative skills

Skills we expect a student to develop/acquire whilst pursuing this project:

  • Infectious disease epidemiology
  • Systematic review and meta-analysis
  • Mathematical modelling
  • Written and oral scientific communication

Routes

Which route/s are available with this project?

  • 1+4 = Yes
  • +4 = Yes

Possible Master’s programme options identified by supervisory team for 1+4 applicants:

  • LSHTM – MSc Epidemiology

Full-time/Part-time Study

Is this project available for full-time study? Yes
Is this project available for part-time study? Yes

Location & Travel

Students funded through MRC LID are expected to work on site at their primary institution. At a minimum, all students must meet the institutional research degree regulations and expectations about onsite working and under this scheme they may be expected to work onsite (in-person) more frequently. Students may also be required to travel for conferences (up to 3 over the duration of the studentship), and for any required training for research degree study and training. Other travel expectations and opportunities highlighted by the supervisory team are noted below.

Day-to-day work (primary location) for the duration of this research degree project will be at: LSHTM – Bloomsbury, London

Travel requirements for this project: None

Eligibility/Requirements

Particular prior educational requirements for a student undertaking this project

  • Minimum standard institutional eligibility criteria for doctoral study at LSHTM
  • Graduate degree in epidemiology, biostatistics, or other quantitative science

Other useful information

  • Potential Industrial CASE (iCASE) conversion? = No

PROJECT IN MORE DETAIL

Scientific description of this research project

This project will generate evidence on effective, equitable, and locally relevant approaches to community screening for tuberculosis. More than 30 years after being declared a public health emergency, tuberculosis remains the leading infectious cause of death globally, and incidence is falling far more slowly than required to end TB. Interrupting ongoing transmission requires expanded efforts to diagnose and treat affected individuals, but evidence on the effectiveness of community screening is mixed. While studies have broadly considered population coverage as a driver of epidemiological impact, they have failed to examine how heterogeneity in screening coverage across specific population groups – in particular, underrepresentation of groups with higher rates of disease – affects the projected impact of screening approaches.

As such, we need to better understand which population groups are reached by different community screening approaches to understand how coverage aligns with the distribution of disease burden and contributions to transmission. From this information, we can estimate how heterogeneity in screening coverage may affect the epidemiological impact of community screening on tuberculosis morbidity and mortality. Finally, we need to translate these insights across settings, where the balance between heterogeneity in coverage and inequities in disease burden may differ, to directly inform local policy decisions. Together, this will lead to more effective, equitable, and locally relevant screening efforts.

Project objectives:
The proposed project will use systematic data synthesis and mathematical modelling to quantify the epidemiological impact of heterogeneity in the coverage of community screening for tuberculosis. This will be achieved through three objectives: 

  1. The student will conduct a systematic review and meta-analysis of community screening studies, activities, and programmes to understand heterogeneity in coverage of different screening approaches across population groups (by age, sex, residence). 
  2. The student will develop a dynamic tuberculosis transmission model incorporating inequities in disease burden to quantify the impact of heterogeneity in screening coverage on tuberculosis morbidity and mortality.  
  3. The student will quantify the epidemiological impact of screening approaches in settings with different epidemiological and demographic profiles to inform policy decisions on effective, equitable, and locally relevant screening approaches.

This will support global policy and national programme decisions on the most effective and equitable community screening approaches for different settings.

Techniques to be used:
The student will use a range of quantitative techniques including systematic review, meta-analysis, other statistics methods, and mathematical modelling.

Confirmed availability of any required databases or specialist materials:
The project will use publicly available data sources, so no specific database access is required to successfully complete the project.

Potential risks to the project and plans for their mitigation:
Risks to the project are expected to be minimal. If results from the systematic review and meta-analysis are too limited to precisely inform subsequent modelling analyses, available data will be used to explore a range of hypothetical scenarios.

Further reading

Relevant preprints and/or open access articles:
(DOI = Digital Object Identifier)

Other pre-application materials: None

Additional information from the supervisory team

The supervisory team has provided a recording for prospective applicants who are interested in their project. This recording should be watched before any discussions begin with the supervisory team.

Horton & Houben Recording

MRC LID LINKS

To apply for a studentship: MRC LID How to Apply
Full list of available projects: MRC LID Projects
For more information about the DTP: MRC LID About Us

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