An Agent-Based Modelling Approach to Investigate the Impact of Sex and Gender on Tuberculosis Transmission: A Case Study of Kampala, Uganda

by James W. G. Doran, Dennis Mujuni, Kit Gallagher, Christian A. Yates, and Ruth Bowness.

This study shows mathematical models can reveal why men have a higher burden of tuberculosis (TB) than women in high‑incidence settings like Kampala. By building an agent‑based model that simulates people’s social contacts and disease progression, we show both biological and behavioural differences impact TB incidence. The model shows sex-specific within‑host factors, like men’s higher likelihood of progression to active disease, have the largest influence on case numbers. Meanwhile, gender-specific between-host factors, especially same-sex mixing and longer male diagnosis delays, drive the above-one male‑to‑female case ratio. This study offers a proof‑of‑concept framework that could support public health planning, after further validation.