Top 10 countries with the greatest reduction in TB incidence

by admin September 25, 2025 512 12 min read

Tuberculosis • Incidence decline • MDR-TB • DOTS

Top-10 Countries Cutting TB Incidence — What Drives Success and Where MDR Risks Remain

Tuberculosis (TB) control hinges on steady incidence decline, high treatment success, and vigilant containment of multidrug-resistant TB (MDR/RR-TB). Using WHO public data and program reports, we highlight ten countries with sustained reductions in TB incidence, summarize their treatment outcomes, and flag MDR-TB risk patterns that demand continued attention.

Methodology (transparent & comparable)

Signal of progress: average annual rate of decline in estimated TB incidence (AARR, %/yr) over the last decade with consistent reporting.
Program strength: latest available treatment success rate (TSR, all forms) for new/relapse cases under DOTS/NTMCP.
Drug resistance lens: MDR/RR-TB among new cases (%), as a proxy for transmission of resistance and quality of basic TB control.
Practicality: we prioritized countries with documented program reforms (e.g., rapid diagnostics scale-up, community DOTS, shorter MDR regimens, social support).

Important: Figures below are rounded planning numbers derived from WHO global TB reporting and country profiles; always consult the latest WHO database for precise estimates and uncertainty intervals.

Abbreviations: AARR — average annual rate of reduction in TB incidence; TSR — treatment success rate; MDR/RR-TB — rifampicin-resistant with/without isoniazid resistance.

What successful countries have in common

Universal rapid testing (Xpert/Truenat) for all presumptive TB, with reflex DST for positives.
Scaled TPT — TB preventive treatment for household contacts and PLHIV, guided by contact investigation.
Community-centered DOTS and adherence support (digital tools, social packages, transport vouchers).
Shorter regimens for drug-susceptible TB and MDR-TB where eligible (e.g., 4–6 month DS-TB; 6–9 month all-oral MDR regimens).
Real-time surveillance and quarterly cohort reviews to fix losses to follow-up and reduce delays.

Executive insight

Countries posting the fastest incidence declines tend to combine aggressive case-finding with early, accurate drug-susceptibility testing and strong adherence systems. However, some of these same settings still face elevated MDR burdens or pockets of transmission in high-risk groups. The lesson: keep pushing basic DOTS quality while ring-fencing resources for MDR prevention, rapid initiation, and completion on all-oral regimens.

Top-10 countries by decline in TB incidence — with treatment success and MDR flags

#	Country	AARR of TB incidence (% per year)	Treatment success (TSR, %)	MDR/RR-TB among new cases (%)	Program levers associated with decline
1	Cambodia	~7.5	~90	~1–2	Community DOTS scale-up; proactive contact investigation; rapid diagnostics coverage; social support for adherence.
2	Viet Nam	~6.5	~88–90	~3–5	Universal Xpert testing; private-sector engagement; TB preventive treatment for contacts; strengthened lab network.
3	China	~6.0	~90	~6–8	County-level DOTS consolidation; digital adherence tools; screening in high-risk groups; scaled DST and treatment coverage.
4	Ethiopia	~6.0	~88	<1	Decentralized DOTS; ACF in pastoral/remote areas; integrated HIV/TB services; TPT expansion.
5	Rwanda	~5.5	~90+	~1	Community health workers; digital reporting; strong contact tracing; patient support packages.
6	Kenya	~5.0	~86	~1–2	Nationwide Xpert rollout; targeted screening (mines, prisons, urban slums); improved specimen transport and gene networks.
7	Tanzania	~5.0	~88	~1	Active case finding in key populations; sample referral systems; community linkage to care and follow-up.
8	Russian Federation	~5.0	~78–82	~25–30	Improved case detection and treatment coverage; MDR program scale-up; but persistent MDR transmission pockets.
9	Belarus	~6.5	~82–85	~30–40	All-oral MDR regimens adoption; rapid DST; infection control; strong lab quality systems, yet high baseline MDR.
10	Kazakhstan	~5.5	~85	~20–30	Programmatic management of drug-resistant TB; shorter all-oral regimens; social support to complete therapy.

Notes: Values are rounded planning figures synthesized from WHO global TB reporting and country profiles to illustrate relative rankings and risk patterns. Always consult the latest WHO database for exact estimates and uncertainty intervals.

How to read this table

AARR captures sustained momentum in reducing incidence. TSR indicates program quality in curing and completing treatment. MDR/RR-TB among new cases signals ongoing transmission of resistance; high percentages warrant intensified prevention and rapid all-oral MDR regimens. Countries with high AARR but elevated MDR need two-track strategies: keep incidence falling while aggressively shrinking the MDR reservoir.

Incidence decline vs MDR risk — Top-10 countries

AARR of TB incidence (%/yr)

Treatment success (TSR, %)

MDR/RR-TB among new cases (%)

Values are rounded mid-points drawn from recent WHO reporting and are for planning/benchmarking, not certification.

Five actions to sustain decline and curb MDR

Close diagnostic gaps. Universal rapid molecular testing for all presumptive TB, with reflex DST and prompt linkage to care.
Scale TB preventive treatment (TPT). Household contacts, PLHIV, and other high-risk groups; digitize contact management.
Adopt shorter, all-oral regimens. For DS-TB (4–6 months) and MDR-TB (6–9 months) where eligible; ensure drug supply continuity.
Reduce loss to follow-up. Community DOTS with incentives, social care, and digital adherence technologies; weekly exception reporting.
Target hotspots. Routine screening in congregate settings (prisons, mines, shelters) and among mobile/urban-poor populations.