A Stochastic Projection for Tuberculosis Elimination in Indonesia by 2030
Abstract
Introduction: Indonesia, with the world's second-highest tuberculosis (TB) burden, has targeted TB elimination (65 cases per 100,000) by 2030. This study aimed to evaluate the feasibility of achieving this goal by projecting TB incidence trends using a stochastic epidemic model that accounts for the uncertainties inherent in TB transmission dynamics in latent TB infections.
Methods: The initial values for state variables and parameters were derived from a comprehensive literature review and calibrated against publicly available epidemiological data from the Indonesian Ministry of Health reports from 2018-2022. A Susceptible, Vaccinated, Three Exposed, Three Infectious, Recovered (SVE3I3R) model was developed, incorporating Gaussian noise into the exposed compartments to simulate real-world unpredictability in latent infection dynamics. The model was solved numerically using the fourth-order Runge-Kutta (RK4) method in R software. Key outcomes measured were the projected incidence of drug-susceptible TB (DS-TB), multidrug-resistant TB (MDR-TB), and extensively drug-resistant TB (XDR-TB).
Results: Model projections suggest that the overall TB incidence rate will fall from 387 cases per 100,000 people in 2023 to a projected 320 cases per 100,000 by 2030. However, this remains far above the national target. While DS-TB cases decreased to 730,283, MDR-TB and XDR-TB cases were projected to surge dramatically to 120,939 cases and 104,651 individuals, respectively. The estimation signals a critical shift in the epidemic's profile.
Conclusions: Indonesia is not on track to achieve its 2030 TB elimination target under current interventions. The alarming rise of drug-resistant TB necessitates an urgent, aggressive, and multifaceted policy response. This study underscores the critical value of incorporating stochasticity into epidemiological models for more realistic forecasting and public health planning in high-burden settings.
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