Tuberculosis (TB) is among the 10 top causes of deaths worldwide, and one-quarter of the world population hosts latent TB pathogens. Therefore, avoiding the emergence of drug-resistant strains has become a central issue in TB control. In this work, we propose a nested model for TB transmission and control, wherein both within-host and between-host dynamics are modeled. We use the model to compare the effects of three types of antibiotic treatment protocols and combinations thereof in an in silico population. For a fixed value of antibiotics clearance rate and relative efficacy against resistant strains, the oscillating intermittent protocol, pure or combined, is the most effective against the sensitive strains. However, this protocol also creates a selective advantage for the resistant strains, returning the worst result in comparison to the other protocols. We suggest that nested models should be further developed, since they might be able to inform decision-makers regarding the optimal TB control protocols to be applied under the specific parameters and other epidemiological factors in different populations.

中文翻译：

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结核病的嵌套模型：在单个框架中结合宿主内和宿主间进程

结核病 (TB) 是全球十大死因之一，世界四分之一的人口携带潜伏的结核病病原体。因此，避免耐药菌株的出现已成为结核病控制的核心问题。在这项工作中，我们提出了一个用于 TB 传输和控制的嵌套模型，其中对宿主内和宿主间的动态进行了建模。我们使用该模型来比较三种类型的抗生素治疗方案及其组合的效果计算机人口。对于抗生素清除率和对耐药菌株的相对效力的固定值，振荡间歇方案，纯的或组合的，对敏感菌株最有效。然而，该协议还为抗性菌株创造了选择性优势，与其他协议相比，返回的结果最差。我们建议应进一步开发嵌套模型，因为它们可能能够告知决策者有关在不同人群的特定参数和其他流行病学因素下应用的最佳结核病控制方案。