Prospects for Tuberculosis Elimination in the United States: Results of a Transmission Dynamic Model

Abstract

We estimated long-term tuberculosis (TB) trends in the US population and assessed prospects for TB elimination. We used a detailed simulation model allowing for changes in TB transmission, immigration, and other TB risk determinants. We evaluated 5 hypothetical scenarios from 2017 to 2100: 1) maintain current TB prevention and treatment activities (base-case), 2) provision of latent TB infection testing and treatment for new legal immigrants, 3) increased uptake of latent TB infection screening and treatment among high-risk populations, including a 3-month isoniazid-rifapentine regimen, 4) improved TB case detection, 5) improved TB treatment quality. Under the base-case, we estimate that by 2050 TB incidence will decline to 14 cases per million, a 52% (95% interval: 35, 67) reduction from 2016, and 82% (78, 86) of incident TB will be among non-US-born persons. Intensified TB control could reduce incidence by 77% (66, 85) by 2050. By 2100, we predict TB may be eliminated in the US-born but not the non-US-born. Results were sensitive to numbers entering the US with latent or active TB, and robust to alternative interpretations of epidemiologic evidence. TB elimination in the US remains a distant goal. However, strengthening TB prevention and treatment could produce important health benefits.