Care-cascade failures as a determinant of infectious burden in tuberculosis: an agent-based modelling study in India

Treatment failure in simulated tuberculosis episodes in India extended median effective infectious time from 3 months (no recorded failure) to 16 months, accounting for 63% of infectiousness-weighted burden.

• Why it matters: Conventional cascade counts can miss delays that prolong infectiousness, sustain transmission, and limit progress toward End TB targets.
• What they did: Using EMOD-TBHIV calibrated to India (2015–2024; 25,894 episodes), the study classified episodes by diagnostic failures and/or treatment failure and projected 2025–2035 impacts of active case finding, improved diagnostics, and treatment support.
• The result: By 2035, treatment support and active case finding reduced incidence versus baseline by 18% and 17%, while the combined package reduced incidence by 34% and prevalence by 85%, but incidence fell only 57% versus 2015.

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