Alvaro Schwalb

Alvaro Schwalb

@aschwalbc.bsky.social

Infectious disease epidemiologist and TB mathematical modeller | Assistant Professor at LSHTM and Associate Researcher at IMTAvH. Tell your dog I said hi.

2.7K followers429 following73 posts

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Alvaro Schwalb
@aschwalbc.bsky.social

1/📢 In our new publication, we estimate that in 2022, 134 million people worldwide had a recent Mycobacterium tuberculosis (Mtb) infection and were at high risk of progressing to TB disease. Read the full paper in PLOS Medicine (tinyurl.com/mtbinfection). #TBSky

tinyurl.comEstimating the global burden of viable Mycobacterium tuberculosis infection: A mathematical modelling studyAlvaro Schwalb and colleagues conducted a mathematical modelling study to estimate the global burden of viable Mycobacterium tuberculosis--that which can cause disease and be transmitted--to help guid...

Alvaro Schwalb reposted

Katherine Horton
@kchorton.bsky.social

#TB is often portrayed as a disease of working age adults, but our new preprint shows prevalence of untreated disease is highest among older adults, who also face the greatest gaps in detection and reporting. www.medrxiv.org/content/10.6...

Peter MacPherson@petermacp.bsky.social

We have a new preprint out: In metaanalysis of 82 #TB surveys (30 countries, 4.6M people), we investigated how prevalence changes with age Untreated TB increases substantially with age, with poorer case detection in older adults. www.medrxiv.org/content/10.6... @uofgshw.bsky.social 🦠🧪🛟

Alvaro Schwalb reposted

Catherynne M. Valente
@catvalente.bsky.social

I don’t care where you started out on the political spectrum If your kid comes out as trans & you don’t become a rainbow-clad, parade-cheering ally & rock-solid supportive girl/boy/enby dad/mom? You were never a parent at all You were a doll collector furious they didn’t stay in their packaging.

Alvaro Schwalb reposted

LSHTM TB Modelling Group
@lshtm-tbmod.bsky.social

New paper from @plosglobalpublichealth.org: which TB screening strategies are the best value as funding shrinks? Modelling clinic/community approaches in 🇿🇦, we found combining strategies reaching risk groups is more cost-effective than any one approach alone doi.org/10.1371/journal.pgph.0006738

doi.orgProjected population level impact and cost-effectiveness of clinic and community-based tuberculosis screening approachesThe South African National Department of Health have set ambitious targets to scale up TB testing, focusing primarily on clinic attendees. In the context of declining funding for TB care and preventio...

Alvaro Schwalb reposted

Jorge Ruiz-Cabrejos
@jruizcabrejos.bsky.social

(Unfortunately) journals do not provide the space in their platforms to share articles in languages other than english. Funding institutions should encourage academia to, at the very least, include translations for the language in which the research is being conducted www.nature.com/articles/d41...

nature.comScientists who don’t speak fluent English get little help from journals, study findsAn analysis of hundreds of journals finds limited efforts to accommodate scientists who are not native English speakers.
BSC-CNS@bsc-cns.bsky.social

🌐Es el idioma una barrera invisible en la ciencia? Un estudio del BSC e @iscb.bsky.social propone un modelo multilingüe para democratizar la investigación global. 🗞Artículo: bsc.es/4SL

Alvaro Schwalb reposted

WHO
@who.int

What are you doing today to take care of yourself and your health and well-being? These could be small habits. Or big changes. Every action you take to protect your health matters.

Alvaro Schwalb reposted

Peter MacPherson
@petermacp.bsky.social

New publication led by Mphatso Phiri: Drivers of sex differences in Mycobacterium tuberculosis immunoreactivity among adolescents and adults in Blantyre, Malawi link.springer.com/article/10.1... @uofgshw.bsky.social @lightontb.bsky.social @kchorton.bsky.social #TB #Episky 🛟🧪

link.springer.comDrivers of sex differences in Mycobacterium tuberculosis immunoreactivity among adolescents and adults in Blantyre, Malawi - BMC Global and Public HealthBackground Sex differences in Mycobacterium tuberculosis (Mtb) exposure likely contribute to sex differences in tuberculosis (TB) burden. However, population-level age- and sex-specific patterns of Mt...

Alvaro Schwalb reposted

Katherine Horton
@kchorton.bsky.social

Our new paper in @nathealth.nature.com shows that population-level #TB interventions are likely to have more meaningful impact on disease burden than interventions that only reach routinely diagnosed individuals or their households. www.nature.com/articles/s44... 1/7

nature.comGlobal impact and cost-effectiveness of tuberculosis interventions - Nature HealthA modelling analysis at a global scale estimates that three interventions (vaccination, community-wide screening and prison screening programmes) could prevent more than 10% of tuberculosis cases betw...

Alvaro Schwalb reposted

LSHTM TB Modelling Group
@lshtm-tbmod.bsky.social

New preprint suggests that combining clinic and community-based approaches is key to maximising the cost-effectiveness of #tuberculosis active case finding in South Africa 🇿🇦 Read more 👉 www.medrxiv.org/content/10.6...

medrxiv.orgProjected population level impact and cost-effectiveness of clinic and community-based tuberculosis screening approachesThe South Africa National Department of Health have set ambitious targets to scale up TB testing, focusing primarily on clinic attendees. In the context of declining funding for TB care and prevention...
Alvaro Schwalb
@aschwalbc.bsky.social

Today, I'll be presenting our work on estimating the global burden of viable Mycobacterium tuberculosis infection at the Advanced TB Diagnostics course, part of the @mcgill.ca Summer Institutes in Global Health. I attended this course in 2019 and am very honoured to be among the speakers now!

Alvaro Schwalb
@aschwalbc.bsky.social

Also, as a fun (?) fact, during that trip, I had a small accident in the flat I was staying in and lost a tooth, so in a way, I left a part of me in Montreal. 🤷‍♂️

Alvaro Schwalb reposted

Rebecca Clark
@raclark18.bsky.social

New publication now out in @lancetgh.bsky.social! New #TB #vaccines are being trialled in older adolescents and adults, and we comment on the advantages and challenges of including younger adolescents who have historically been excluded. www.thelancet.com/journals/lan...

thelancet.comInclusion of young adolescents in policy development for new tuberculosis vaccinesThe infant tuberculosis vaccine, BCG, prevents severe tuberculosis disease, but protection is rarely durable beyond childhood. New tuberculosis vaccines are being developed for the prevention of infec...

Alvaro Schwalb reposted

Lara Goscé
@laragosce.bsky.social

Poverty is a major driver of TB.Conditional cash transfers combined with counselling improve pre-treatment loss to follow-up.In this economic analysis our modelling projections show that this intervention is cost-effective and can reduce incidence and mortality. www.sciencedirect.com/science/arti...

sciencedirect.comCost-effectiveness of conditional cash transfers with pre- and post-test tuberculosis counselling in South Africa: a modelling analysisTuberculosis (TB) disproportionately affects low-income populations due to socioeconomic barriers. Conditional cash transfers (CCTs) are promising str…

Alvaro Schwalb reposted

Finn McQuaid
@cfmcquaid.bsky.social

So...what would happen to the global TB epidemic if we "eliminated" undernutrition? Our paper out now @lancetgh.bsky.social, where we combined estimates from our review (doi.org/10.1093/ije/...) with population-specific BMI distributions to find out...(www.sciencedirect.com/science/arti...)

sciencedirect.comGlobal, regional, and national estimates of tuberculosis incidence averted by eliminating undernutrition in adults: a modelling studyCurrent efforts to reduce global tuberculosis incidence have proved insufficient, highlighting that urgent action is needed to address underlying modi…

Alvaro Schwalb reposted

PLOS Medicine
@plosmedicine.org

In this mathematical modelling study, Katherine Horton & co assess #TB community screening approaches & their estimated effects on TB incidence & mortality, concluding that methods that capture both infectious & non-infectious TB are needed to achieve sustained case reductions🧪 plos.io/4tuD2SM

plos.ioTrade-offs in diagnostic algorithm, population coverage, and duration of community screening for tuberculosis: A modelling studyIn a mathematical modelling study, Katherine Horton and colleagues assess different tuberculosis (TB) community screening approaches and their estimated effects on TB incidence and mortality over ten ...

Alvaro Schwalb reposted

Katherine Horton
@kchorton.bsky.social

In our latest paper in @plosmedicine.org, we explore trade-offs in diagnostic algorithm, coverage, and duration of community screening for #TB, highlighting the importance of symptom-agnostic approaches and the need for strategies to sustain impact when screening ends. plos.io/4tuD2SM

PLOS Medicine@plosmedicine.org

In this mathematical modelling study, Katherine Horton & co assess #TB community screening approaches & their estimated effects on TB incidence & mortality, concluding that methods that capture both infectious & non-infectious TB are needed to achieve sustained case reductions🧪 plos.io/4tuD2SM

plos.ioTrade-offs in diagnostic algorithm, population coverage, and duration of community screening for tuberculosis: A modelling studyIn a mathematical modelling study, Katherine Horton and colleagues assess different tuberculosis (TB) community screening approaches and their estimated effects on TB incidence and mortality over ten ...

Alvaro Schwalb reposted

Alex Richards
@alexandra-richards.bsky.social

A year after my last day with @lshtm-tbmod.bsky.social my work on modelling the impact of increasing men's access to care and reducing excess risk of TB has gone live @commsmed.nature.com www.nature.com/articles/s43...

nature.comModelling the impact of increasing tuberculosis treatment coverage and addressing determinants of risk in men - Communications MedicineRichards et al. use a compartmental transmission model of tuberculosis to understand the impact of strategies to improve men’s access to care and to reduce men’s excess risk of TB. In all four countri...
The LIGHT Consortium @lightontb.bsky.social

What if targeting TB in men could benefit entire populations? This new modelling study from @alexandra-richards.bsky.social suggests exactly that 👇 ✔️ More treatment coverage ✔️ Address social & structural risks 👉 Big reductions in TB incidence & mortality 🔗 www.nature.com/articles/s43...

Alvaro Schwalb reposted

Peter MacPherson
@petermacp.bsky.social

New study led by @alexandra-richards.bsky.social. Reducing men’s TB risk and improving treatment access could have big impacts on #TB incidence and deaths for men, women, and children. www.nature.com/articles/s43... @kchorton.bsky.social @uofgshw.bsky.social @lightontb.bsky.social

The LIGHT Consortium @lightontb.bsky.social

What if targeting TB in men could benefit entire populations? This new modelling study from @alexandra-richards.bsky.social suggests exactly that 👇 ✔️ More treatment coverage ✔️ Address social & structural risks 👉 Big reductions in TB incidence & mortality 🔗 www.nature.com/articles/s43...

Alvaro Schwalb reposted

Katherine Horton
@kchorton.bsky.social

Our analysis of #TB exposure and transmission patterns is now in @pnas.org. @petedodd24.bsky.social and I found a majority of TB transmission globally is attributable to contact with adult men, while contributions to transmission by age are more variable across regions. www.pnas.org/doi/10.1073/...

Katherine Horton@kchorton.bsky.social

Understanding patterns of #TB exposure and transmission is needed for targeted prevention strategies. In our latest pre-print, @petedodd24.bsky.social and I estimated the proportion of TB exposure to and transmission from sex and age groups for 177 countries. bit.ly/4nbV492

medrxiv.orgA global analysis of patterns of tuberculosis exposure and transmissionTuberculosis (TB) is a major public health concern and the leading infectious cause of mortality globally. The disease exhibits strong prevalence patterns by age and sex, but the implications of these...

Alvaro Schwalb reposted

Rebecca Clark
@raclark18.bsky.social

Our recent modelling study found that the estimated impact of new TB vaccines depends on the efficacy to prevent infectious asymptomatic TB. Read more in our paper out now in @plosmedicine.org! journals.plos.org/plosmedicine...

journals.plos.orgEstimating the population impact of new tuberculosis vaccines depending on efficacy against infectious asymptomatic tuberculosis: A modelling studyHira Tanvir and colleagues estimate the potential impact of new tuberculosis vaccines under three scenarios of efficacy and conclude that to achieve the greatest impact, vaccines must prevent asymptom...

Alvaro Schwalb reposted

Finn McQuaid
@cfmcquaid.bsky.social

We know conflict & crises have severe repercussions for TB; health system disruptions, displacement, food insecurity... In our latest paper we examine the effects of war in Ukraine on engagement with a digital adherence tech by people w TB & health care workers journals.theunion.org/content/ijtl...

journals.theunion.orgThe effects of war on digital adherence technology engagement for TB treatment in UkraineSUMMARYBACKGROUNDThe Russian invasion of Ukraine in February 2022 has disrupted TB care. We examine the effects of the war on people with drug-susceptible TB (PWTB) and health care worker (HCW) engagement with a digital adherence technology (DAT).METHODSWe conducted a cluster-randomised trial of a DAT intervention in Ukraine. In the intervention arm, PWTB received a pillbox with a daily treatment reminder. Pillbox openings were captured real-time onto a platform, accessed by HCWs who could add manual doses where relevant. We compared DAT engagement in pre-, early-, and later-war periods.RESULTSFrom June 2021 to 2022, 816 PWTB (32% women, median age 44 years) were enrolled. DAT engagement varied across regions and time period, with a decline in engagement post-February 2022. PWTB DAT engagement was 78%–84% of treatment-days. There was a three- to four-fold increase in unknown dose or delays in manual reporting of adherence (>7 days) post-February 2022 versus pre-war in Mykolaivska and Donetska oblasts and a two-fold increase in Odeska, Lvivska, and Zakarpatska oblasts.CONCLUSIONThe war significantly disrupted DAT engagement, particularly in regions heavily affected by the conflict. Reduced engagement was likely due to migration and communication challenges. There is a critical need for resilient TB care in conflict settings.
Alvaro Schwalb
@aschwalbc.bsky.social

7/ In summary, we incorporate new insights that reflect the dynamic nature of TB to provide a medically actionable estimate of the global population harbouring viable Mtb infection (tinyurl.com/mtbinfection). We urgently need tools that detect viable Mtb rather than relying on immunoreactivity.

tinyurl.comEstimating the global burden of viable Mycobacterium tuberculosis infection: A mathematical modelling studyAlvaro Schwalb and colleagues conducted a mathematical modelling study to estimate the global burden of viable Mycobacterium tuberculosis--that which can cause disease and be transmitted--to help guid...
Alvaro Schwalb
@aschwalbc.bsky.social

5/ We found that in 2022, 134 million people (95% UI: 104–171) were recently infected with Mtb, equating to 1.7% (95% UI: 1.3–2.2) of the global population. In total, 289 million people (95% UI: 242–343), or 3.7% of the global population, were estimated to harbour viable Mtb infection.

Alvaro Schwalb
@aschwalbc.bsky.social

6/ We observed substantial regional variability. Of all recent infections, over 87% were found in the three WHO regions of Southeast Asia, the Western Pacific, and Africa. At the country level, India, Indonesia, and China collectively accounted for about 50% of recent global Mtb infections.

Alvaro Schwalb
@aschwalbc.bsky.social

3/ First, we adjusted annual infection risk (ARI) trends for immunoreactivity reversion and age-specific mixing to better capture the force of infection. Second, we incorporated self-clearance of Mtb and calibrated rates using simulated infection-to-disease pathways (tinyurl.com/tbpath).

tinyurl.comReevaluating progression and pathways following Mycobacterium tuberculosis infection within the spectrum of tuberculosis | PNASTraditional understanding of the risk of progression from Mycobacterium tuberculosis (Mtb) infection to tuberculosis (TB) overlooks diverse present...
Alvaro Schwalb
@aschwalbc.bsky.social

4/ We focused on recent infections, acknowledging that the highest risk of progression to disease occurs within two years of infection. By integrating these insights, our model generated estimates for 171 countries (covering 99.6% of the global population), all six WHO regions, and globally.

Alvaro Schwalb
@aschwalbc.bsky.social

2/ One quarter of the world was estimated to have ‘latent’ TB infection (tinyurl.com/ltbinf), but this reflects immunoreactivity after exposure, not viable infection. Incorporating insights on reversion, age-specific mixing, and self-clearance, we provide estimates of viable Mtb infection.

tinyurl.comThe Global Burden of Latent Tuberculosis Infection: A Re-estimation Using Mathematical ModellingIn this mathematical modelling study, Rein Houben and colleagues provide updated estimates of latent tuberculosis infection worldwide and its implications of this reservoir with respect to goals for e...

Alvaro Schwalb reposted

Finn McQuaid
@cfmcquaid.bsky.social

@lshtm-tbmod.bsky.social is offering multiple PhD opportunities through MRC LID, deadline 14 Jan. More details: mrc-lid.lshtm.ac.uk/applicants/ Projects include #1 TB & screening #2 TB & climate change #3 TB & vaccines #4 TB & influenza #5 TB & prevention @cmmid-lshtm.bsky.social @lshtm.bsky.social

mrc-lid.lshtm.ac.ukInformation for applicants - MRC London Intercollegiate Doctoral Training Partnership StudentshipsMRC LID studentship information for applicants How to Apply Projects Studentship funding Studentship options Studentship...
Alvaro Schwalb
@aschwalbc.bsky.social

The most important news of the day. #TBSky

Kate LeGrand@lekate.bsky.social

Perhaps the most important collaboration at #UnionConf2025? WHO STOP TB’s Hello Kitty met the LSHTM TB Modelling Group’s bunny mascot “Bugs” today 🐰 Shout out to @stoptb.bsky.social and @lshtm-tbmod.bsky.social for making TB epidemiology both rigorous and accessible. #EndTB #WCLH2025

Alvaro Schwalb reposted

The Lancet Infectious Diseases
@thelancetinfdis.bsky.social

New comment: Tuberculosis and undernutrition: improving estimates to reinforce the policy imperative www.thelancet.com/journals/lan...

thelancet.comTuberculosis and undernutrition: improving estimates to reinforce the policy imperativeUndernutrition is a key driver of the global tuberculosis epidemic, increasing the risk of people developing tuberculosis disease and of poor outcomes in those who do.1 Each year, WHO publishes estima...

Alvaro Schwalb reposted

chaelinkim.bsky.social
@chaelinkim.bsky.social

When fluoroquinolone resistance status is unknown, empirical use of BPaLM (adding moxifloxacin to BPaL) is cost-effective as a replacement for BPaL even with high fluoroquinolone resistance levels! 🦠💊 doi.org/10.1371/jour...

doi.orgImpact of fluoroquinolone resistance on the cost-effectiveness of empiric treatment for multidrug- or rifampicin-resistant tuberculosisThe WHO recommends the bedaquiline, pretomanid, and linezolid (BPaL) regimen with the additional fluoroquinolone antibiotic moxifloxacin (BPaLM) for initial treatment of multidrug- or rifampicin-resis...

Alvaro Schwalb reposted

Katherine Horton
@kchorton.bsky.social

Understanding patterns of #TB exposure and transmission is needed for targeted prevention strategies. In our latest pre-print, @petedodd24.bsky.social and I estimated the proportion of TB exposure to and transmission from sex and age groups for 177 countries. bit.ly/4nbV492

medrxiv.orgA global analysis of patterns of tuberculosis exposure and transmissionTuberculosis (TB) is a major public health concern and the leading infectious cause of mortality globally. The disease exhibits strong prevalence patterns by age and sex, but the implications of these...

Alvaro Schwalb reposted

Rein Houben
@reinhouben.bsky.social

In a new preprint (NOT PEER REVIEWED) we continue to explore the challenge of overtreatment in community screening. It seems the benefits of TB treatment far outweigh the harms, especially once we accept that sputum culture is not perfect. Important food for thought. www.medrxiv.org/content/10.1...

medrxiv.orgDo no harm - re-evaluating the risks of overtreatment in community-wide tuberculosis screeningBackground Community-wide screening is a crucial strategy to end tuberculosis (TB), but a common concern is potential harm from overtreatment following false positive diagnoses. However, current refer...