next 3 years. This prolonged increase in risk is similar to that seen in low-incidence countries, 8 suggesting that even in this high-burden setting, reactivation rather than reinfection dominates the risk in these initial years. Together, these results support giving preventive treatment to adult household contacts in high-incidence settings. Moreover, household interventions provide a platform for delivering preventive treatment in adults, who are already being assessed as part of contact investigations and whose children or younger siblings might already be receiving preventive treatment. Comprehensive approaches that actively detected, prevented, and treated all forms of tuberculosis were key to pronounced declines in tuberculosis in New York in the 1990s 9 and in Alaska decades earlier. 10 Achieving the Sustainable Development Goal of ending the global tuberculosis epidemic by 2030 will require proactive use of the full arsenal of interventions available today, and rapid integration of innovation, to promptly reach high-risk and vulnerable populations with preventive and curative treatments. 11,12 Tuberculosis has long been recognised as a disease linked to inequality; active casefinding strategies that promote equity are essential to disrupt that link.