Feasibility of achieving the 2025 WHO global tuberculosis targets in South Africa, China, and India: a combined analysis of 11 mathematical models.
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Houben Rein M G J, Menzies Nicolas A, Sumner Tom, Huynh Grace H, Arinaminpathy Nimalan, Goldhaber-Fiebert Jeremy D, Lin Hsien-Ho, Wu Chieh-Yin, Mandal Sandip, Pandey Surabhi, Suen Sze-Chuan, Bendavid Eran, Azman Andrew S, Dowdy David W, Bacaër Nicolas, Rhines Allison S, Feldman Marcus W, Handel Andreas, Whalen Christopher C, Chang Stewart T, Wagner Bradley G, Eckhoff Philip A, Trauer James M, Denholm Justin T, McBryde Emma S, Cohen Ted, Salomon Joshua A, Pretorius Carel, Lalli Marek, Eaton Jeffrey W, Boccia Delia, Hosseini Mehran, Gomez Gabriela B, Sahu Suvanand, Daniels Colleen, Ditiu Lucica, Chin Daniel P, Wang Lixia, Chadha Vineet K, Rade Kiran, Dewan Puneet, Hippner Piotr, Charalambous Salome, Grant Alison D, Churchyard Gavin, Pillay Yogan, Mametja L David, Kimerling Michael E, Vassall Anna, White Richard G
Аннотация
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.