A rapid communication in the journal Euro Surveillance assessed the progress towards the Sustainable Development Goals (SDG) targets for tuberculosis (TB) elimination.
One of the main targets outlined in the SDG was to eliminate TB as a global public health threat by 2030. Based on the World Health Organization (WHO) End TB Strategy, some of the sub-targets were to achieve an 80% reduction in TB incidence and a 90% decrease in deaths due to TB by 2030.
Rapid communication: Monitoring the progress achieved towards ending tuberculosis in the European Union/European Economic Area, 2018 to 2021
Background
The first United Nations General Assembly high-level meeting (UNHLM) on TB was held in September 2018, following the ambitious political declaration of fast-tracking the target of ending TB by 2030.
Between 2018 and 2022, about 40 million people were treated for TB, which comprised 3.5 million children and 1.5 million people with drug-resistant TB. Monitoring of UNHLM treatment assumed that all recorded TB cases were receiving effective treatments.
About the Study
The study estimated key global and regional targets associated with TB for the European Union and European Economic Area (EU/EEA). The authors used STATA/SE 17 and Microsoft Excel for their analysis. This study obtained relevant notification data for TB cases from the European Surveillance System (TESSy), which was used as a proxy for TB incidence. Population data to calculate the incidence rate was extracted from Eurostat on April 2022.
Scientists predicted whether the 2030 End TB targets could be reached based on the average annual change in notification rate between 2015 and 2021. They also considered the average annual change in the number of deaths in the same period.
Study Findings
To reach an 80% reduction in TB incidence by 2030, considering the 2015 baseline results, the EU/EEA has to reach 2.4 TB cases per 100,000 population. It was observed that the average annual decline between 2015 and 2021 was 6.8%, compared to 3.8% between 2015 and 2019.
Based on a 6.8% annual decline rate, it has been projected that the EU/EEA will reach 3.9 TB infections per 100,000 population in 2030. Therefore, an annual decline of 11.7% is required from 2022 onwards to each 2.4 TB cases per 100,000 population by 2030.
TB deaths continuously declined between 2015 and 2020, with an average annual decline of 6.5% compared with 3.6% from 2015 to 2019. To reach the 2030 target, an annual average decline of 17.5% per year is needed.
In the EU/EEA countries, an overall reduction was observed, irrespective of age group, to reach the UNHLM targets on TB treatment initiation. The number of individuals initiating multidrug-resistant (MDR) TB treatment declined from 68.1% in 2018 to 43.7% in 2021.
124,844 TB cases of all ages were noticed between 2018 and 2020, and treatment was initiated. A 12-monthly follow-up was conducted to determine the effectiveness of the treatment. The authors estimated the treatment success range between 54.1% and 51.5% for all ages. Among the notified MDR TB cases, the treatment was effective among 49.4% of individuals diagnosed in 2018 and 46.3% of those diagnosed in 2019.
In the overall study period (2018 to 2021), the EU/EEA countries achieved around 80% of the UNHLM targets, particularly on TB diagnosis and treatment initiation in all age groups of TB patients. However, a decline in rates was observed in 2019. This was mostly due to the coronavirus disease 2019 (COVID-19) pandemic, which impacted the implementation of TB prevention, control, and surveillance measures. The current study did not conduct modeling projections to assess how COVID-19 affected TB incidence.
Conclusions
The current study has some limitations, including using proxies for TB incidence and treatment initiation. There is a possibility of under-reporting and misclassification of deaths due to TB. Nevertheless, this methodology has been supported by previous studies. This study did not analyze data on a country level but included the available relevant information collected from different sources.
Even though earlier assessments revealed a continual decrease in TB incidence and deaths, the current report has shown an increase in TB incidence. The rate of decline in TB incidence changed from an earlier report of 6.8% to 6.5% in the new assessment report. These numbers project that if the same numbers are maintained, the goal of ending TB by 2030 will not be achieved.
To achieve these goals, new strategies must be implemented to increase methods to identify TB cases and develop new TB preventive treatments. In addition, more people-centered support must be formulated to help individuals with MDR TB. There is a need for improved shorter and all-oral TB treatment regimens.
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