Present and Future Trajectory of Tuberculosis Globally and In Af-ghanistan from 1990 to 2040: A Modelling Study

Background: Tuberculosis (TB) continues to disproportionately affect vulnerable populations in conflict zones like Afghanistan, remaining a significant global health concern. We aimed to analyze TB trends in Afghanistan from 1990 to 2021 and projects the future burden to 2040, informing evidence-based public health planning. Methods: Using sex-specific epidemiological data from the Global Burden of Disease (GBD) study (1990–2021), we projected the future prevalence of TB in Afghanistan and globally through 2040. We employed an illness-death model (IDM), calibrated to the GBD data to generate these projections. Results: From 1990 to 2021, the global age-standardized prevalence rate (ASPR) of TB decreased by 23%, with projections indicating a further 6% decline by 2040. Afghanistan demonstrated a more substantial historical reduction of 43% and is forecast to achieve an additional 41% decrease by 2040. Although starting from a lower baseline than the global average, Afghanistan’s rate of improvement is significantly more rapid. Projections for Afghanistan are associated with greater uncertainty, largely due to unique socio-political challenges. Nonetheless, these trends highlight the considerable progress made by the country despite major operational constraints. Conclusion: While projections suggest potential progress in TB control, recent increases in case notifications and wide uncertainty intervals highlight that epidemiological outcomes in fragile states depend on political and economic factors as much as biomedical interventions, especially where case detection is suboptimal.