Ending tuberculosis in Gulf Cooperation Council countries: an overview of the WHO End TB Strategy 2025 milestones

Objectives: Tuberculosis (TB) continues to pose a major global public health challenge. Although the Gulf Cooperation Council (GCC) countries have lower incidence rates of TB (<10 cases per million population), they are still striving to maintain and surpass benchmarks. We describe TB status to the 2025 milestones of the World Health Organization (WHO) End TB Strategy. Methods: A retrospective study conducted using WHO data published from 2015 and between 2020 and 2023 highlights trends in TB incidence, mortality, treatment success, and drug resistance across GCC countries. Results: Kuwait had the most significant drop in TB infections since 2015, with a reduction of 57%, followed by Qatar at 40% and Saudi Arabia at 31%. Oman, however, recorded a 23% increase. In terms of TB-related deaths, Saudi Arabia achieved a 32% decrease, whereas Qatar, Kuwait, and the United Arab Emirates experienced increases of 14%, 39%, and 22% respectively. Treatment success rates were highest in Qatar (100%), Oman (90%), and Saudi Arabia (87%), whereas Kuwait (44%) and Bahrain (77%) had the lowest rates. Oman reported the highest reduction in multidrug-resistant TB cases at (60%), followed by Saudi Arabia (50%), Kuwait (31%), and Bahrain (50%). Qatar had the highest increase (122%) and United Arab Emirates had no change, reflecting varying degrees of success in controlling drug-resistant TB. HIV-TB co-infection rates was highest in United Arab Emirates (5.4%) and Bahrain (5.1%), followed by Saudi Arabia (2.3%), Oman (1.4%), Qatar (0.6%), and Kuwait (0.5%). Notably, the GCC countries reported zero TB households, with no catastrophic overall expenses since 2020. Conclusions: Although the GCC countries have made significant strides in TB control, their efforts toward the targets have been inconsistent, with notable differences in TB-related deaths, infection rates, treatment success, and multidrug-resistant TB rates. Strengthening regional collaboration, implementing targeted interventions, and integrating services are essential to meet the WHO's 2025 and 2035 goals.