Tuberculosis in Southeast Asia Region

A recent study highlights that optimal implementation of tuberculosis preventive therapy (TPT) in Southeast Asia Region (SEAR) countries could potentially reduce the annual TB incidence rate by 8.30% compared to 2015 figures. TPT services are widely provided to household contacts over five years of age and to other high-risk groups in these countries. Notably, Indonesia and Maldives extend these services to prisoners, and Timor-Leste to individuals who are undernourished or have diabetes.[1]

Sri Lanka diverges in its approach by considering all pulmonary TB cases for TPT, not just bacteriologically confirmed ones, focusing primarily on contacts below 15 or over 50 years of age. In terms of treatment protocols, India specifies different TPT regimens depending on the resistance profile of the index patient. All countries in the region are committed to monitoring TPT adherence closely, often coordinated with routine healthcare visits or, for PLHIV, synchronized with their ART medication refills.[1]

Operational research identified several priorities to enhance TPT implementation, including developing comprehensive strategies for provider training and patient counseling, improving diagnostic access like X-ray for contact investigation, and strengthening health system capacities. These initiatives are aimed at integrating TPT into a broader TB management framework to ensure effective and targeted TB prevention, ultimately contributing to the global goal of reducing TB incidence.[1]

A study evaluates whether Southeast Asian Region (SEAR) countries are poised to meet the WHO's interim End TB targets of reducing tuberculosis incidence by 50% and mortality by 75% by 2025 compared to 2015 levels. The analysis uses data from the WHO Global Health Observatory and Global Health Estimates, applying Joinpoint Regression to examine trends from 2000–2018 for incidence and until 2016 for mortality, alongside ARIMA forecasting to project trends through to 2025. Region-wide, slight declines in age-standardized incidence rates (ASIR) and stronger declines in age-standardized mortality rates (ASMR) are noted, but the projections fall short of the WHO targets, indicating an overall 17.3% reduction in incidence and 25.8% in mortality by 2025.[2]

The study highlights significant variations among individual countries within SEAR. India, Myanmar, and Indonesia are projected to see declines in both ASIR and ASMR, with Myanmar nearing target levels (50% reduction in ASIR and 60.3% in ASMR). Conversely, Bangladesh, Nepal, Sri Lanka, and Timor-Leste are expected to either experience increases in these rates or only minimal changes. The Maldives, due to low numbers, had minimal or no forecast data available. The forecasting models underscore the disparate trends across the region, with some countries showing promising declines while others face stagnating or worsening tuberculosis burdens. The study concludes that most SEAR countries are unlikely to achieve the WHO's ambitious End TB targets by the stipulated 2025 deadline.[2]

References:

1. Giridharan, P., Suseela, R.P., Zangpo, T., Joshi, R.B., Cader, M., Isbaniah, F., Velayudham, B., Rafeeg, F.N., da Cruz Santos, A., Shah, N.P. and Mathew, M., 2024. Tuberculosis preventive treatment in eight SEAR countries–Current practices, implementation challenges and operations research priorities. Public Health in Practice, 8, p.100518.

2. Krishnamoorthy, Y., Nagarajan, R., Rajaa, S., Majella, M.G., Murali, S. and Jayaseelan, V., 2021. Progress of South East Asian Region countries towards achieving interim End TB Strategy targets for TB incidence and mortality: a modelling study. Public Health, 198, pp.9-16.