Assessing the impact of the TB response in Taiwan - the journey towards ending TB.

Abstract

The incidence of TB in Taiwan declined by 62% from 2005 to 2023 (i.e., from 73/100,000 to 28/100,000). Here we review the past two decades of TB epidemiology, policy implementation, and outcomes, identifying gaps and solutions for domestic and global responses. An external review in 2024 assessed National TB Program progress towards the End TB goal, integrating feedback from an International Review Panel and a 2023 expert questionnaire. The findings informed Phase III (2026-2030) of the 'End TB by 2035 Project'. We present review materials, consensus recommendations, and follow-ups through 2024. In 2023, 64% of the TB cases were aged ≥ 65. TB incidence among those < 60 is projected to meet the End TB targets (<10/100,000) by 2035, while elimination (<1 per million) is expected among 0-14-year-olds. During 2005-2024, Taiwan universally adopted new diagnostic tools for drug-resistant TB, shorter regimens and user-friendly platforms for reporting and case management. Nationwide policy innovations included active case finding, and TB infection (TBI) treatment. Taiwan's consistent investment in TB reflects strong political commitment to End TB. Current challenges include aging, co-morbidities, high TB/TBI among foreign migrant workers and societal disparities, and we suggest that future efforts must leverage artificial intelligence, universal genotyping and greater inter-departmental collaboration.