Modelling the impact of TB superinfection on the dynamics of HIV-TB coinfection

In this thesis, a mathematical model describing the interaction between HIV and TB in the presence of TB superinfection is presented. The model takes into account two strains of Mycobacterium tuberculosis (MTB), where one strain is drug-sensitive and the other is resistant to at least one of the first-line anti-tuberculosis drugs. The impact of TB superinfection on the incidence and prevalence of TB in HIV-negative and HIVTB coinfected individuals is evaluated. Various control measures such as condom use, antiretroviral therapy, isoniazid preventive therapy and increased TB detection are studied using this model. Numerical results show that TB superinfection increases the prevalence and incidence of TB and its impact is more in HIV-negative than HIV-TB coinfected individuals. The results also show that TB superinfection promotes strain coexistence and increases the associated HIV mortality. Increased condom use was found to have a high positive impact towards the control of the two epidemics. Antiretroviral therapy decreases the TB notification rate and its impact on HIV prevalence increases with the coverage and efficacy. Isoniazid preventive therapy has a clear effect on the TB prevalence. Finally, increased TB detection was found to have a less impact on the TB incidence in HIV-TB coinfected individuals. Opsomming In hierdie verhandeling word ́n wiskundige model vir die interaksie tussen MIV en TB, in ́n situasie met TB superinfeksie voorgelê. Die model neem twee variante van TB in ag. Een van die variante is sensitief vir MTB behandeling, terwyl die ander weerstandig is vir ten minste een van die eerste-linie TB behandenings. Die impak van TB superinfeksie op die insidensie and prevalensie van TB in MIV negatiewe en MIV-TB ko-gẽınfekteerde individu word ondersoek. Veskeie beheer maatreels soos kondoom gebruik, anti-retrovirale behandeling (vir MIV) en isonazid voorkomende behandeling en verhoodge TB deteksie (vir TB) word ondersoek. Numeriese resultate wys TB superinfeksie verhoog die prevalense en insidensie van TB en dat dit ́n groter bydrae maak by MIV negatief as by MIV-TB ko-geinfekteerde individu. Die resultate wys veder TB superinfeksie promofeer variant kohabitasie en verhoog MIV verwante mortalitieit. Verhoogde kondoom gebruik is gevind om ́n positiewe bydrae te maak tot die beheer van beide epidemies. Anti-retrovirale terapie verlaag die TB aanmeldings koers en die impak van ART verhoog saam met ́n verhoging in die dekking en effektiwiteit daarvan. Voorkomende behandeling het ́n beduidende impak op TB prevalensie. Ons vind dat TB deteksie ́n beperkte impak maak op TB insidensie by MIV-TB ko-geinfekteerde individu.