Feasibility of achieving the 2025 WHO global tuberculosis targets in South Africa, China, and India: a combined analysis of 11 mathematical models

Rein M G J Houben, Nicolas A. Menzies, Tom Sumner, Grace H. Huynh, Nimalan Arinaminpathy, Jeremy D. Goldhaber-Fiebert, Hsien Ho Lin, Chieh Yin Wu, Sandip Mandal, Surabhi Pandey, Sze chuan Suen, Eran Bendavid, Andrew Azman, David Wesley Dowdy, Nicolas Bacaër, Allison S. Rhines, Marcus W. Feldman, Andreas Handel, Christopher C. Whalen, Stewart T. ChangBradley G. Wagner, Philip A. Eckhoff, James M. Trauer, Justin T. Denholm, Emma S. McBryde, Ted Cohen, Joshua A. Salomon, Carel Pretorius, Marek Lalli, Jeffrey W. Eaton, Delia Boccia, Mehran Hosseini, Gabriela B. Gomez, Suvanand Sahu, Colleen Daniels, Lucica Ditiu, Daniel P. Chin, Lixia Wang, Vineet K. Chadha, Kiran Rade, Puneet Dewan, Piotr Hippner, Salome Charalambous, Alison D. Grant, Gavin Churchyard, Yogan Pillay, L. David Mametja, Michael E. Kimerling, Anna Vassall, Richard G. White

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Abstract

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. Funding Bill and Melinda Gates Foundation

Original languageEnglish (US)
Pages (from-to)e806-e815
JournalThe Lancet Global Health
Volume4
Issue number11
DOIs
Publication statusPublished - Nov 1 2016

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ASJC Scopus subject areas

  • Medicine(all)

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Houben, R. M. G. J., Menzies, N. A., Sumner, T., Huynh, G. H., Arinaminpathy, N., Goldhaber-Fiebert, J. D., ... White, R. G. (2016). Feasibility of achieving the 2025 WHO global tuberculosis targets in South Africa, China, and India: a combined analysis of 11 mathematical models. The Lancet Global Health, 4(11), e806-e815. https://doi.org/10.1016/S2214-109X(16)30199-1