Accelerating progress towards tuberculosis elimination: the need for combination treatment and prevention

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Global Health Policy

Background:

• Global tuberculosis (TB) incidence is declining, but progress towards Millennium Development Goal (MDG) targets remains insufficient.
• High human immunodeficiency virus (HIV) prevalence settings present unique challenges to TB control efforts.
• Current strategies may not be adequate to meet ambitious TB reduction goals without adaptation.

Purpose of the Study:

• To evaluate the impact of current TB control strategies in high HIV prevalence settings.
• To identify essential components for accelerating progress towards eliminating new TB infections, deaths, and suffering.
• To inform policy and resource allocation for effective TB response.

Main Methods:

• Two independent mathematical modeling exercises were conducted using South African data.
• Models incorporated different structures and assumptions to assess TB control scenarios.
• Analysis focused on the period until new TB drugs, diagnostics, and vaccines become available.

Main Results:

• Current TB control approaches are unlikely to achieve MDG targets without strategic adjustments.
• A fully funded and accessible combination strategy for TB treatment and prevention is crucial.
• Local TB epidemiology and evidence-informed policy are key determinants of success.

Conclusions:

• A paradigm shift in the global TB response is necessary, particularly in high HIV settings.
• Integrated TB treatment and prevention strategies, informed by local data, are vital.
• Sustained progress towards zero TB requires immediate and comprehensive action, even in the absence of novel interventions.