An Evaluation of the 2035 WHO End TB Targets in 40 High Burden Countries

Cha, J.; Thwaites, G. E.; Ashton, P. M.

Tuberculosis (TB) is the leading global cause of death from a single infectious agent, with more than 10 million new cases annually. As a part of its efforts to control TB, the World Health Organisation (WHO) adopted the End TB Strategy in 2014 to reduce TB incidence by 90% between 2015 and 2035, with intermediate targets every five years. We examined TB incidence data from 2000 to 2018 for 40 high burden countries (HBCs) from the WHO published statistics, contextualized and assessed trends over time, and projected incidence to 2035 for each country. Two recurrent patterns accounted for 26 of the 40 HBCs: linear decrease (n = 14) or a peak in the 2000s followed by decline (n = 12). As uncontrolled HIV is the greatest risk factor for TB, we assessed trends in TB in HIV infected people and TB in HIV uninfected people separately in 15 Sub-Saharan African countries with high HIV prevalence. The projections of current trends were compared against the reductions required to meet the WHO End TB targets. Of the 25 countries without a high burden of TB, only 5 are on track to meet the End TB targets: Ethiopia, Laos, Myanmar, Russia, and South Korea. Of the 15 high HIV burden countries, 6 are on track to meet the End TB targets: Eswatini, Kenya, Lesotho, South Africa, Tanzania, and Zimbabwe. Overall, we predict 62 million excess cases of TB between 2020 and 2035 in the 29 HBCs projected to miss the WHO End TB targets. In high HIV burden countries, new programs aimed directly at TB will be required to maintain momentum. Moreover, our projections are based on data prior to the COVID-19 pandemic; the disruption of the pandemic is overwhelmingly likely to interrupt vital TB services and increase TB incidence. We anticipate that these findings will help orientate countries to their progress towards the End TB goals and inform the level of investment required to meet these important targets for a TB-free world.