Global and Regional Trends in Multidrug- or Rifampicin-Resistant Tuberculosis, 2000-2024 with Forecasts to 2030
1
Health Care Management, University of Sharjah, Sharjah, United Arab Emirates
Popul. Med. 2026;8(Supplement Supplement 1):A137
ABSTRACT
OBJECTIVES:
Tuberculosis remains the world's leading infectious killer, with 8.2 million new cases reported in 2023. Multidrug- or rifampicin-resistant TB (MDR/RR-TB) continues to drive disproportionate mortality worldwide. To analyze trends in MDR/RR-TB prevalence across global regions 2000-2025, with forecasts to 2030.
METHODS:
We conducted a systematic analysis to assess MDR/RR-TB prevalence among tuberculosis patients. Five databases were searched for studies published between 01/2010 and 06/2025. Pooled prevalence was estimated using a random-effects model. Subgroup analyses stratified results by age, sex, WHO region, study period, sample size, and TB burden.
RESULTS:
Our meta-analysis included 102 studies (4.12 million cases; 66.1% male, weighted mean age 39.47 years [SD 5.7]) across 52 countries. Global pooled MDR-TB prevalence declined significantly from 14.4% (95% CI 9.0–19.8) in 2000–2009 to 2.6% (2.3–2.9) in 2020–2024. Africa reported the highest regional burden: prevalence fell from 31.0% (17.3–44.6) to 4.9% (2.8–7.1) over the same period, exceeding other WHO regions in 2020–2024 (Americas: 1.3%; Europe: 1.4%; South-East Asia: 2.6%). Globally, prevalence was higher among males (12.0%, 10.8–13.3) than females (9.7%, 8.6–10.7) and markedly elevated in previously treated patients (19.8%, 18.2–21.4) versus new cases (5.9%, 5.2–6.6). Africa demonstrated distinct epidemiology: the male-female gap narrowed (males: 16.9% [13.5–20.4]; females: 16.3% [12.7–20.0]), and patients aged <40 years faced disproportionately high prevalence (16.9% [13.8–20.0] vs. global: 4.9% [4.1–5.7]). Previously treated African patients had the highest burden (26.2%, 19.6–32.8), exceeding the global average (18.2%, 16.4–19.9). The pooled prevalence of MDR/RR-TB in HIV coinfection patients in Africa (22.2%, 17.2–27.1) is 2.3-fold higher than the global average excluding Africa (9.7% [8.5–10.9]).
CONCLUSIONS:
While global MDR/RR-TB prevalence has significantly declined, Africa continues to bear a disproportionate burden, particularly among retreatment cases, young adults, and HIV-positive patients. The projected rise to 2030 underscores a critical public health imperative for African regions and highlight the urgent need for targeted interventions.
Tuberculosis remains the world's leading infectious killer, with 8.2 million new cases reported in 2023. Multidrug- or rifampicin-resistant TB (MDR/RR-TB) continues to drive disproportionate mortality worldwide. To analyze trends in MDR/RR-TB prevalence across global regions 2000-2025, with forecasts to 2030.
METHODS:
We conducted a systematic analysis to assess MDR/RR-TB prevalence among tuberculosis patients. Five databases were searched for studies published between 01/2010 and 06/2025. Pooled prevalence was estimated using a random-effects model. Subgroup analyses stratified results by age, sex, WHO region, study period, sample size, and TB burden.
RESULTS:
Our meta-analysis included 102 studies (4.12 million cases; 66.1% male, weighted mean age 39.47 years [SD 5.7]) across 52 countries. Global pooled MDR-TB prevalence declined significantly from 14.4% (95% CI 9.0–19.8) in 2000–2009 to 2.6% (2.3–2.9) in 2020–2024. Africa reported the highest regional burden: prevalence fell from 31.0% (17.3–44.6) to 4.9% (2.8–7.1) over the same period, exceeding other WHO regions in 2020–2024 (Americas: 1.3%; Europe: 1.4%; South-East Asia: 2.6%). Globally, prevalence was higher among males (12.0%, 10.8–13.3) than females (9.7%, 8.6–10.7) and markedly elevated in previously treated patients (19.8%, 18.2–21.4) versus new cases (5.9%, 5.2–6.6). Africa demonstrated distinct epidemiology: the male-female gap narrowed (males: 16.9% [13.5–20.4]; females: 16.3% [12.7–20.0]), and patients aged <40 years faced disproportionately high prevalence (16.9% [13.8–20.0] vs. global: 4.9% [4.1–5.7]). Previously treated African patients had the highest burden (26.2%, 19.6–32.8), exceeding the global average (18.2%, 16.4–19.9). The pooled prevalence of MDR/RR-TB in HIV coinfection patients in Africa (22.2%, 17.2–27.1) is 2.3-fold higher than the global average excluding Africa (9.7% [8.5–10.9]).
CONCLUSIONS:
While global MDR/RR-TB prevalence has significantly declined, Africa continues to bear a disproportionate burden, particularly among retreatment cases, young adults, and HIV-positive patients. The projected rise to 2030 underscores a critical public health imperative for African regions and highlight the urgent need for targeted interventions.
| eISSN: | 2654-1459 |
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