Eight-year tuberculosis epidemic trends in the Republic of Congo, a high TB burden country: progress and gaps towards end-TB targets

BACKGROUND: Evaluating progress towards WHO End Tuberculosis Strategy goals is crucial for high burden countries like the Republic of Congo. This study analysed trends in tuberculosis (TB) incidence, treatment, care quality and operational research activities from 2016 to 2023 to assess the country's control efforts. METHODS: An 8-year retrospective study of TB incidence/mortality trends was performed using a Joint Point Analysis V.5.2.0. We extracted annual national and WHO TB programme data for the period under review. RESULTS: From 2016 to 2023, the TB incidence rate decreased by 2.6% (annual percentage change (APC)=-0.33, 95% CI- 0.5 to -0.005; p<0.05). The proportion of bacteriologically confirmed cases significantly increased (APC=4.2, 95% CI 0.9 to 7.7; p<0.001), while treatment coverage rose by 22% (APC=2.81, 95% CI 1.1 to 4.5; p<0.05). The proportion of notified patients with TB tested for HIV significantly increased (APC=25, 95% CI 2.6 to 52.63; p<0.05), but the rate of patients with TB testing HIV positive decreased significantly (APC=-13.9, 95% CI -23.9 to -2.6; p<0.05). The proportion of unsuccessful treatment outcomes showed a non-significant decline, with an APC of 4.90% (95% CI -11.7% to 2.3%; p=0.1), while TB-related deaths increased non-significantly, with an APC of 3.76% (95% CI -1.3% to 9.2%; p=0.12). Patients with TB/HIV on ART increased by 51% (APC=6.4, 95% CI -23.9 to -2.6; p<0.05). No operational research activity has been carried out throughout the review period. CONCLUSION: The observed progress was insufficient, as the Republic of Congo failed to meet the 20% TB incidence reduction target for 2020 and is unlikely to achieve the 50% reduction goal for 2025. More investment in case detection, diagnosis, treatment quality and the implementation of operational research activities is needed to achieve global goals.