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

摘要

Background The post-2015 End TB Strategy proposes targets of 50% reduction in tuberculosis incidence and 75%udreduction in mortality from tuberculosis by 2025. We aimed to assess whether these targets are feasible in threeudhigh-burden countries with contrasting epidemiology and previous programmatic achievements.udMethods 11 independently developed mathematical models of tuberculosis transmission projected the epidemiologicaludimpact of currently available tuberculosis interventions for prevention, diagnosis, and treatment in China, India, andudSouth Africa. Models were calibrated with data on tuberculosis incidence and mortality in 2012. Representatives fromudnational tuberculosis programmes and the advocacy community provided distinct country-specifi c interventionudscenarios, which included screening for symptoms, active case fi nding, and preventive therapy.udFindings Aggressive scale-up of any single intervention scenario could not achieve the post-2015 End TB Strategyudtargets in any country. However, the models projected that, in the South Africa national tuberculosis programmeudscenario, a combination of continuous isoniazid preventive therapy for individuals on antiretroviral therapy, expandedudfacility-based screening for symptoms of tuberculosis at health centres, and improved tuberculosis care could achieveuda 55% reduction in incidence (range 31–62%) and a 72% reduction in mortality (range 64–82%) compared with 2015udlevels. For India, and particularly for China, full scale-up of all interventions in tuberculosis-programme performanceudfell short of the 2025 targets, despite preventing a cumulative 3·4 million cases. The advocacy scenarios illustrated theudhigh impact of detecting and treating latent tuberculosis.udInterpretation Major reductions in tuberculosis burden seem possible with current interventions. However, additionaludinterventions, adapted to country-specifi c tuberculosis epidemiology and health systems, are needed to reach theudpost-2015 End TB Strategy targets at country level.