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Lancet Glob Health. 2016 Nov;4(11):e806-e815. doi: 10.1016/S2214-109X(16)30199-1. Epub 2016 Oct 6.

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

Author information

1
TB Modelling Group, TB Centre, London School of Hygiene and Tropical Medicine, London, UK; Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK. Electronic address: rein.houben@lshtm.ac.uk.
2
Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA.
3
TB Modelling Group, TB Centre, London School of Hygiene and Tropical Medicine, London, UK; Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK.
4
Institute for Disease Modeling, Seattle, WA, USA.
5
Department of Infectious Disease Epidemiology, Imperial College London, London, UK; Public Health Foundation of India, Delhi NCR, India.
6
Stanford Health Policy, Centers for Health Policy and Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA.
7
Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
8
Public Health Foundation of India, Delhi NCR, India.
9
Management Science and Engineering Dept, Stanford University, Stanford, CA, USA.
10
Department of Medicine, Stanford University, Stanford, CA, USA.
11
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
12
IRD, UMMISCO, Bondy, France.
13
Department of Biology, Stanford University, Stanford, CA, USA; Johnson & Johnson Global Public Health, Raritan, NJ, USA.
14
Department of Biology, Stanford University, Stanford, CA, USA.
15
Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA.
16
The Burnet Institute, Melbourne, Australia; The Victorian Infectious Diseases Service, at the Peter Doherty Institute, Melbourne, Australia; Department of Microbiology and Immunology, the University of Melbourne at the Peter Doherty Institute, Melbourne, Australia.
17
The Victorian Infectious Diseases Service, at the Peter Doherty Institute, Melbourne, Australia; Department of Microbiology and Immunology, the University of Melbourne at the Peter Doherty Institute, Melbourne, Australia.
18
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
19
Avenir Health, Glastonbury, CT, USA.
20
Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
21
Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK.
22
Strategic Information Department, The Global Fund, Geneva, Switzerland.
23
Department of Global Health, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Institute for Global Health and Development, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
24
Stop TB Partnership, Geneva, Switzerland.
25
Bill and Melinda Gates Foundation, China Office, Beijing, China.
26
National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
27
Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, India.
28
World Health Organization, Country Office for India, New Delhi, India.
29
The Bill & Melinda Gates Foundation, New Delhi, India.
30
Aurum Institute. Johannesburg, South Africa.
31
Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
32
Aurum Institute. Johannesburg, South Africa; School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
33
National Department of Health, Pretoria, South Africa.
34
Bill and Melinda Gates foundation, Seattle, WA, USA (currently KNCV Tuberculosisn Foundation, The Hague, Netherlands).
35
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.

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.

PMID:
27720688
DOI:
10.1016/S2214-109X(16)30199-1
[Indexed for MEDLINE]
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