title: Feasibility of achieving the 2025 WHO global tuberculosis targets in South Africa, China, and India: a combined analysis of 11 mathematical models.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  Bill and Melinda Gates Foundation.
authors.affiliation: 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.
authors.forename: Rein M G J
authors.initials: RMGJ
authors.lastname: Houben
authors.affiliation: Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA.
authors.forename: Nicolas A
authors.initials: NA
authors.lastname: Menzies
authors.affiliation: 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.
authors.forename: Tom
authors.initials: T
authors.lastname: Sumner
authors.affiliation: Institute for Disease Modeling, Seattle, WA, USA.
authors.forename: Grace H
authors.initials: GH
authors.lastname: Huynh
authors.affiliation: Department of Infectious Disease Epidemiology, Imperial College London, London, UK; Public Health Foundation of India, Delhi NCR, India.
authors.forename: Nimalan
authors.initials: N
authors.lastname: Arinaminpathy
authors.affiliation: Stanford Health Policy, Centers for Health Policy and Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Goldhaber-Fiebert
authors.affiliation: Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Hsien-Ho
authors.initials: HH
authors.lastname: Lin
authors.affiliation: Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Chieh-Yin
authors.initials: CY
authors.lastname: Wu
authors.affiliation: Public Health Foundation of India, Delhi NCR, India.
authors.forename: Sandip
authors.initials: S
authors.lastname: Mandal
authors.affiliation: Public Health Foundation of India, Delhi NCR, India.
authors.forename: Surabhi
authors.initials: S
authors.lastname: Pandey
authors.affiliation: Management Science and Engineering Dept, Stanford University, Stanford, CA, USA.
authors.forename: Sze-Chuan
authors.initials: SC
authors.lastname: Suen
authors.affiliation: Department of Medicine, Stanford University, Stanford, CA, USA.
authors.forename: Eran
authors.initials: E
authors.lastname: Bendavid
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Azman
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Dowdy
authors.affiliation: IRD, UMMISCO, Bondy, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bacaër
authors.affiliation: Department of Biology, Stanford University, Stanford, CA, USA; Johnson & Johnson Global Public Health, Raritan, NJ, USA.
authors.forename: Allison S
authors.initials: AS
authors.lastname: Rhines
authors.affiliation: Department of Biology, Stanford University, Stanford, CA, USA.
authors.forename: Marcus W
authors.initials: MW
authors.lastname: Feldman
authors.affiliation: Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA.
authors.forename: Andreas
authors.initials: A
authors.lastname: Handel
authors.affiliation: Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Whalen
authors.affiliation: Institute for Disease Modeling, Seattle, WA, USA.
authors.forename: Stewart T
authors.initials: ST
authors.lastname: Chang
authors.affiliation: Institute for Disease Modeling, Seattle, WA, USA.
authors.forename: Bradley G
authors.initials: BG
authors.lastname: Wagner
authors.affiliation: Institute for Disease Modeling, Seattle, WA, USA.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Eckhoff
authors.affiliation: 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.
authors.forename: James M
authors.initials: JM
authors.lastname: Trauer
authors.affiliation: 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.
authors.forename: Justin T
authors.initials: JT
authors.lastname: Denholm
authors.affiliation: 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.
authors.forename: Emma S
authors.initials: ES
authors.lastname: McBryde
authors.affiliation: Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
authors.forename: Ted
authors.initials: T
authors.lastname: Cohen
authors.affiliation: Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Salomon
authors.affiliation: Avenir Health, Glastonbury, CT, USA.
authors.forename: Carel
authors.initials: C
authors.lastname: Pretorius
authors.affiliation: 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.
authors.forename: Marek
authors.initials: M
authors.lastname: Lalli
authors.affiliation: Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Eaton
authors.affiliation: Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Delia
authors.initials: D
authors.lastname: Boccia
authors.affiliation: Strategic Information Department, The Global Fund, Geneva, Switzerland.
authors.forename: Mehran
authors.initials: M
authors.lastname: Hosseini
authors.affiliation: Department of Global Health, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Institute for Global Health and Development, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
authors.forename: Gabriela B
authors.initials: GB
authors.lastname: Gomez
authors.affiliation: Stop TB Partnership, Geneva, Switzerland.
authors.forename: Suvanand
authors.initials: S
authors.lastname: Sahu
authors.affiliation: Stop TB Partnership, Geneva, Switzerland.
authors.forename: Colleen
authors.initials: C
authors.lastname: Daniels
authors.affiliation: Stop TB Partnership, Geneva, Switzerland.
authors.forename: Lucica
authors.initials: L
authors.lastname: Ditiu
authors.affiliation: Bill and Melinda Gates Foundation, China Office, Beijing, China.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Chin
authors.affiliation: National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Lixia
authors.initials: L
authors.lastname: Wang
authors.affiliation: Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, India.
authors.forename: Vineet K
authors.initials: VK
authors.lastname: Chadha
authors.affiliation: World Health Organization, Country Office for India, New Delhi, India.
authors.forename: Kiran
authors.initials: K
authors.lastname: Rade
authors.affiliation: The Bill & Melinda Gates Foundation, New Delhi, India.
authors.forename: Puneet
authors.initials: P
authors.lastname: Dewan
authors.affiliation: Aurum Institute. Johannesburg, South Africa.
authors.forename: Piotr
authors.initials: P
authors.lastname: Hippner
authors.affiliation: Aurum Institute. Johannesburg, South Africa.
authors.forename: Salome
authors.initials: S
authors.lastname: Charalambous
authors.affiliation: Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Alison D
authors.initials: AD
authors.lastname: Grant
authors.affiliation: Aurum Institute. Johannesburg, South Africa; School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
authors.forename: Gavin
authors.initials: G
authors.lastname: Churchyard
authors.affiliation: National Department of Health, Pretoria, South Africa.
authors.forename: Yogan
authors.initials: Y
authors.lastname: Pillay
authors.affiliation: National Department of Health, Pretoria, South Africa.
authors.forename: L David
authors.initials: LD
authors.lastname: Mametja
authors.affiliation: Bill and Melinda Gates foundation, Seattle, WA, USA (currently KNCV Tuberculosisn Foundation, The Hague, Netherlands).
authors.forename: Michael E
authors.initials: ME
authors.lastname: Kimerling
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Vassall
authors.affiliation: 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.
authors.forename: Richard G
authors.initials: RG
authors.lastname: White
mesh_terms: D000124:Achievement; D000995:Antitubercular Agents / Q000627:therapeutic use; D002423:Cause of Death; D002681:China; D003695:Delivery of Health Care; D005544:Forecasting; D006040:Goals; D015658:HIV Infections / Q000150:complications; D006297:Health Services Accessibility; D006801:Humans; D015994:Incidence; D007194:India; D007538:Isoniazid / Q000627:therapeutic use; D008403:Mass Screening; D008962:Models, Theoretical; D013019:South Africa; D014376:Tuberculosis / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy / Q000635:transmission; D014944:World Health Organization
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid