Abstract
SummaryBackgroundThe post-2015 End TB Strategy proposes targets of 50% reduction in tuberculosis incidence and 75% reduction in mortality from tuberculosis by 2025. We aimed to assess whether these targets are feasible in three high-burden countries with contrasting epidemiology and previous programmatic achievements.Methods11 independently developed mathematical models of tuberculosis transmission projected the epidemiological impact of currently available tuberculosis interventions for prevention, diagnosis, and treatment in China, India, and South Africa. Models were calibrated with data on tuberculosis incidence and mortality in 2012. Representatives from national tuberculosis programmes and the advocacy community provided distinct country-specific intervention scenarios, which included screening for symptoms, active case finding, and preventive therapy.FindingsAggressive scale-up of any single intervention scenario could not achieve the post-2015 End TB Strategy targets in any country. However, the models projected that, in the South Africa national tuberculosis programme scenario, a combination of continuous isoniazid preventive therapy for individuals on antiretroviral therapy, expanded facility-based screening for symptoms of tuberculosis at health centres, and improved tuberculosis care could achieve a 55% reduction in incidence (range 31–62%) and a 72% reduction in mortality (range 64–82%) compared with 2015 levels. For India, and particularly for China, full scale-up of all interventions in tuberculosis-programme performance fell short of the 2025 targets, despite preventing a cumulative 3·4 million cases. The advocacy scenarios illustrated the high impact of detecting and treating latent tuberculosis.InterpretationMajor reductions in tuberculosis burden seem possible with current interventions. However, additional interventions, adapted to country-specific tuberculosis epidemiology and health systems, are needed to reach the post-2015 End TB Strategy targets at country level.FundingBill and Melinda Gates Foundation
Highlights
In May, 2014, the World Health Assembly approved the post-2015 End TB Strategy, setting “ambitious but feasible” targets for reducing the global burden of tuberculosis by 2035.1,2 The strategy is aiming for a 50% reduction in global tuberculosis incidence and a 75% reduction in global tuberculosis mortality by 2025, and 90% and 95% reductions in these outcomes, respectively, by 2035.2 Policy makers must identify what interventions, and at which level of scale-up, will be needed to meet these targets at country level
Because the required information is not always available in a systematic way in the public domain, involvement of local experts is key. In this Article, we describe epidemiological projections from 11 independently developed dynamic transmission models of tuberculosis, exploring the feasibility of the 2025 End TB Strategy targets in China, India, and South Africa
In South Africa, models were calibrated to an epidemiological burden and trend in 2012, but diverged over time as the projected baseline change in incidence between 2015 and 2025 ranged from 0 to 25%
Summary
In May, 2014, the World Health Assembly approved the post-2015 End TB Strategy, setting “ambitious but feasible” targets for reducing the global burden of tuberculosis by 2035.1,2 The strategy is aiming for a 50% reduction in global tuberculosis incidence and a 75% reduction in global tuberculosis mortality by 2025, and 90% and 95% reductions in these outcomes, respectively, by 2035.2 Policy makers must identify what interventions, and at which level of scale-up, will be needed to meet these targets at country level.The End TB targets are deliberately ambitious, and any single intervention (defined here as a group of activities leading to an improvement in a specific area of tuberculosis control—eg, treatment outcomes) is unlikely to achieve these goals.[3]. In May, 2014, the World Health Assembly approved the post-2015 End TB Strategy, setting “ambitious but feasible” targets for reducing the global burden of tuberculosis by 2035.1,2 The strategy is aiming for a 50% reduction in global tuberculosis incidence and a 75% reduction in global tuberculosis mortality by 2025, and 90% and 95% reductions in these outcomes, respectively, by 2035.2 Policy makers must identify what interventions, and at which level of scale-up, will be needed to meet these targets at country level. For both phases of the End TB Strategy, policy makers require guidance about which interventions and technologies to use—questions that are unlikely to be answered by empirical studies, given
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