Understanding the heterogeneous spread of tuberculosis (TB), particularly multidrug-resistant (MDR) forms and the role of subclinical infection, is critical for achieving the WHO End TB strategy. This study develops a novel compartmental model that explicitly incorporates incipient and subclinical TB together with MDR forms, and links them to case detection and treatment pathways. The key innovation lies in integrating a sensitivity-based identifiability analysis with a Bayesian MCMC framework to quantify parameter uncertainty and correlations directly from regional surveillance data. Applied to five high-burden regions of the Russian Federation (2009–2020), the approach reveals strong heterogeneity in epidemic drivers: wide credible intervals for contagiousness, the rate of progression to bacterio-positive (BE+) states, and detection rates. The probabilistic forecasts up to 2025 are validated against 2021–2023 data. The region-specific differences in these correlated parameters dictate transmission dynamics, and improving detection of BE+ cases is the most effective lever for control.
Krivorot’ko et al. (2026) studied this question.