Predicting Treatment Adherence of Tuberculosis Patients at Scale

Tuberculosis (TB), an infectious bacterial disease, is a significant cause of death, especially in low-income countries, with an estimated ten million new cases reported globally in $2020$. While TB is treatable, non-adherence to the medication regimen is a significant cause of morbidity and mortality. Thus, proactively identifying patients at risk of dropping off their medication regimen enables corrective measures to mitigate adverse outcomes. Using a proxy measure of extreme non-adherence and a dataset of nearly $700,000$ patients from four states in India, we formulate and solve the machine learning (ML) problem of early prediction of non-adherence based on a custom rank-based metric. We train ML models and evaluate against baselines, achieving a $\sim 100\%$ lift over rule-based baselines and $\sim 214\%$ over a random classifier, taking into account country-wide large-scale future deployment. We deal with various issues in the process, including data quality, high-cardinality categorical data, low target prevalence, distribution shift, variation across cohorts, algorithmic fairness, and the need for robustness and explainability. Our findings indicate that risk stratification of non-adherent patients is a viable, deployable-at-scale ML solution. As the official AI partner of India's Central TB Division, we are working on multiple city and state-level pilots with the goal of pan-India deployment.

Interpretability of Epidemiological Models : The Curse of Non-Identifiability

Interpretability of epidemiological models is a key consideration, especially when these models are used in a public health setting. Interpretability is strongly linked to the identifiability of the underlying model parameters, i.e., the ability to estimate parameter values with high confidence given observations. In this paper, we define three separate notions of identifiability that explore the different roles played by the model definition, the loss function, the fitting methodology, and the quality and quantity of data. We define an epidemiological compartmental model framework in which we highlight these non-identifiability issues and their mitigation.