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.

Keywords: End TB strategies; TB elimination; policy implementation; tuberculosis.

Figure 1.

TB incidence rates stratified by age groups, 2005–2023.

Figure 2.

Foreign-born TB in 2006–2023 stratified by 4 types of residence permits, including foreign workers, foreign spouses, foreign students and foreigners (others) and the ratio of foreign-born TB compared to foreign-born and Taiwanese national TB. Clear triangles = total number of foreign-born TB; clear circles = the proportion of foreign-born TB of foreign-born and Taiwanese national TB (%).

Figure 3.

A: The projected TB incidence towards 2035 with the trend fitting by TB incidence during 2005–2023. To predict TB incidence from 2024 to 2035, an interrupted time series model was used. A negative binomial distribution was assumed for annual number of newly confirmed TB. Due to the rapidly aging society in Taiwan, the prediction for crude TB incidence for all age in 2035 is further adjusted to account for the age distribution expected in that year and the adjusted TB incidence for all ages is therefore 17.7/100,000 population. B: The projected TB incidence towards 2035 with age stratifications during 2005-2023. Black circles = observed data 2005–2023; clear circles = estimation 2024–2035; shaded area = trend and 95% CI; AAPC = average annual percent change; Inc = incidence; pop = population.

Figure 4.

The trend number of multi-drug resistant TB (MDR-TB), rifampin resistant TB (RR-TB) without isoniazid resistance, chronic patients and people living with MDR-TB after implementation of patient-centered care, government-initiated hospital-based program for MDR-TB, the Taiwan MDR-TB Consortium, 2007–2023.

Figure 5.

Uptake of TB infection treatment and coverage rate of directly observed preventive therapy. Black bar = No. of contacts with TBI received TPT; gray bar = No. of high-risk populations with TBI received TPT; clear circles = DOPT coverage rate (%) for TPT. TBI = TB infection; No. = number; TPT = TB preventive therapy; DOPT = directly observed preventive therapy.