TY - JOUR
T1 - Feasibility of achieving the 2025 WHO global tuberculosis targets in South Africa, China, and India
T2 - a combined analysis of 11 mathematical models
AU - Houben, Rein M.G.J.
AU - Menzies, Nicolas A.
AU - Sumner, Tom
AU - Huynh, Grace H.
AU - Arinaminpathy, Nimalan
AU - Goldhaber-Fiebert, Jeremy D.
AU - Lin, Hsien Ho
AU - Wu, Chieh Yin
AU - Mandal, Sandip
AU - Pandey, Surabhi
AU - Suen, Sze chuan
AU - Bendavid, Eran
AU - Azman, Andrew S.
AU - Dowdy, David W.
AU - Bacaër, Nicolas
AU - Rhines, Allison S.
AU - Feldman, Marcus W.
AU - Handel, Andreas
AU - Whalen, Christopher C.
AU - Chang, Stewart T.
AU - Wagner, Bradley G.
AU - Eckhoff, Philip A.
AU - Trauer, James M.
AU - Denholm, Justin T.
AU - McBryde, Emma S.
AU - Cohen, Ted
AU - Salomon, Joshua A.
AU - Pretorius, Carel
AU - Lalli, Marek
AU - Eaton, Jeffrey W.
AU - Boccia, Delia
AU - Hosseini, Mehran
AU - Gomez, Gabriela B.
AU - Sahu, Suvanand
AU - Daniels, Colleen
AU - Ditiu, Lucica
AU - Chin, Daniel P.
AU - Wang, Lixia
AU - Chadha, Vineet K.
AU - Rade, Kiran
AU - Dewan, Puneet
AU - Hippner, Piotr
AU - Charalambous, Salome
AU - Grant, Alison D.
AU - Churchyard, Gavin
AU - Pillay, Yogan
AU - Mametja, L. David
AU - Kimerling, Michael E.
AU - Vassall, Anna
AU - White, Richard G.
N1 - Publisher Copyright:
© 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license
PY - 2016/11/1
Y1 - 2016/11/1
N2 - Background The 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. Methods 11 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. Findings Aggressive 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. Interpretation Major 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.
AB - Background The 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. Methods 11 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. Findings Aggressive 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. Interpretation Major 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.
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U2 - 10.1016/S2214-109X(16)30199-1
DO - 10.1016/S2214-109X(16)30199-1
M3 - Article
C2 - 27720688
AN - SCOPUS:84992379364
SN - 2214-109X
VL - 4
SP - e806-e815
JO - The Lancet Global Health
JF - The Lancet Global Health
IS - 11
ER -