Fighting and Preventing Tuberculosis

In the past decade, breakthroughs of Artificial Intelligence (AI) in its multiple sub-area have made new applications in various domains possible. One typical yet essential example is the public health domain. There are many challenges for humans in our never-ending battle with diseases. Among them, problems involving harnessing data with network structures and future planning, such as disease control or resource allocation, demand effective solutions significantly. However, unfortunately, some of them are too complicated or unscalable for humans to solve optimally. This thesis tackles these challenging sequential network planning problems for the public health domain by advancing the state-of-the-art to a new level of effectiveness.

In particular, My thesis provides three main contributions to overcome the emerging challenges when applying sequential network planning problems in the public health domain, namely (1) a novel sequential network-based screening/contact tracing framework under uncertainty, (2) a novel sequential network-based mobile interventions framework, (3) theoretical analysis, algorithmic solutions and empirical experiments that shows superior performance compared to previous approaches both theoretically and empirically.

More concretely, the first part of this thesis studies the active screening problem as an emerging application for disease prevention. I introduce a new approach to modeling multi-round network-based screening/contact tracing under uncertainty. Based on the well-known network SIS model in computational epidemiology, which is applicable for many diseases, I propose a model of the multi-agent active screening problem (ACTS) and prove its NP-hardness. I further proposed the REMEDY (REcurrent screening Multi-round Efficient DYnamic agent) algorithm for solving this problem. With a time and solution quality trade-off, REMEDY has two variants, Full- and Fast-REMEDY. It is a Frank-Wolfe-style gradient descent algorithm realized by compacting the representation of belief states to represent uncertainty. As shown in the experiment conducted, Full- and Fast-REMEDY are not only being superior in controlling diseases to all the previous approaches; they are also robust to varying levels of missing
information in the social graph and budget change, thus enabling
the use of our agent to improve the current practice of real-world
screening contexts.

The second part of this thesis focuses on the scalability issue for the time horizon for the ACTS problem. Although Full-REMEDY provides excellent solution qualities, it fails to scale to large time horizons while fully considering the future effect of current interventions. Thus, I proposed a novel reinforcement learning (RL) approach based on Deep Q-Networks (DQN). Due to the nature of the ACTS problem, several challenges that the traditional RL can not handle have emerged, including (1) the combinatorial nature of the problem, (2) the need for sequential planning, and (3) the uncertainties in the infectiousness states of the population. I design several innovative adaptations in my RL approach to address the above challenges. I will introduce why and how these adaptations are made in this part.

For the third part, I introduce a novel sequential network-based mobile interventions framework. It is a restless multi-armed bandits (RMABs) with network pulling effects. In the proposed model, arms are partially recharging and connected through a graph. Pulling one arm also improves the state of neighboring arms, significantly extending the previously studied setting of fully recharging bandits with no network effects. Such network effect may arise due to regular population movements (such as commuting between home and work) for mobile intervention applications. In my thesis, I show that network effects in RMABs induce strong reward coupling that is not accounted for by existing solution methods. I also propose a new solution approach for the networked RMABs by exploiting concavity properties that arise under natural assumptions on the structure of intervention effects. In addition, I show the optimality of such a method in idealized settings and demonstrate that it empirically outperforms state-of-the-art baselines.

Community Health Workers (CHWs) form an important component of health-care systems globally, especially in low-resource settings. CHWs are often tasked with monitoring the health of and intervening on their patient cohort. Previous work has developed several classes of Restless Multi-Armed Bandits (RMABs) that are computationally tractable and indexable, a condition that guarantees asymptotic optimality, for solving such health monitoring and intervention problems (HMIPs).
However, existing solutions to HMIPs fail to account for risk-sensitivity considerations of CHWs in the planning stage and may run the danger of ignoring some patients completely because they are deemed less valuable to intervene on.
Additionally, these also rely on patients reporting their state of adherence accurately when intervened upon. Towards tackling these issues, our contributions in this paper are as follows: 
(1) We develop an RMAB solution to HMIPs that allows for reward functions that are monotone increasing, rather than linear, in the belief state and also supports a wider class of observations.
(2) We prove theoretical guarantees on the asymptotic optimality of our algorithm for any arbitrary reward function. Additionally, we show that for the specific reward function considered in previous work, our theoretical conditions are stronger than the state-of-the-art guarantees.
(3) We show the applicability of these new results for addressing the three issues pertaining to: risk-sensitive planning, equitable allocation and reliance on perfect observations as highlighted above. We evaluate these techniques on both simulated as well as real data from a prevalent CHW task of monitoring adherence of tuberculosis patients to their prescribed medication in Mumbai, India and show improved performance over the state-of-the-art. The simulation code is available at: https://github.com/AdityaMate/risk-aware-bandits.

We propose and study Collapsing Bandits, a new restless multi-armed bandit (RMAB) setting in which each arm follows a binary-state Markovian process with a special structure: when an arm is played, the state is fully observed, thus “collapsing” any uncertainty, but when an arm is passive, no observation is made, thus allowing uncertainty to evolve. The goal is to keep as many arms in the “good” state as possible by planning a limited budget of actions per round. Such Collapsing Bandits are natural models for many healthcare domains in which health workers must simultaneously monitor patients and deliver interventions in a way that maximizes the health of their patient cohort. Our main contributions are as follows: (i) Building on the Whittle index technique for RMABs, we derive conditions under which the Collapsing Bandits problem is indexable. Our derivation hinges on novel conditions that characterize when the optimal policies may take the form of either “forward” or “reverse” threshold policies. (ii) We exploit the optimality of threshold policies to build fast algorithms for computing the Whittle index, including a closed form. (iii) We evaluate our algorithm on several data distributions including data from a real-world healthcare task in which a worker must monitor and deliver interventions to maximize their patients’ adherence to tuberculosis medication. Our algorithm achieves a 3-order-of-magnitude speedup compared to state-of-the-art RMAB techniques, while achieving similar performance.

Digital Adherence Technologies (DATs) are an increasingly popular method for verifying patient adherence to many medications.
We analyze data from one city served by 99DOTS, a phone-callbased DAT deployed for Tuberculosis (TB) treatment in India where
nearly 3 million people are afflicted with the disease each year. The
data contains nearly 17,000 patients and 2.1M dose records. We lay
the groundwork for learning from this real-world data, including
a method for avoiding the effects of unobserved interventions in
training data used for machine learning. We then construct a deep
learning model, demonstrate its interpretability, and show how it
can be adapted and trained in three different clinical scenarios to
better target and improve patient care. In the real-time risk prediction setting our model could be used to proactively intervene with
21% more patients and before 76% more missed doses than current
heuristic baselines. For outcome prediction, our model performs
40% better than baseline methods, allowing cities to target more
resources to clinics with a heavier burden of patients at risk of failure. Finally, we present a case study demonstrating how our model
can be trained in an end-to-end decision focused learning setting to
achieve 15% better solution quality in an example decision problem
faced by health workers.