Tackling The Spread

1. Structural & Environmental Drivers of TB Spread

• Overcrowding and poor prison conditions (e.g., Lhokseumawe Prison at 400% capacity) significantly increase TB transmission risk.
• Housing conditions, like inadequate ventilation and high density, though intuitively risky, showed no direct statistical link in one study—but malnutrition was strongly associated with TB incidence (OR ≈ 4.6).
• Climate variables (minimum temperature, rainfall) in Brunei showed delayed but significant links to TB incidence, suggesting environmental factors may indirectly drive TB via behavior or immunity shifts.
• Feasible interventions: Decongest prisons and improve inmate health screenings. Address nutrition systematically in vulnerable communities and facilities. Incorporate climate-related surveillance in TB forecasting in tropical areas.

See also: Lin TB Lab NTU

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2. Biological and Comorbidity Risk Factors

• Comorbidities, especially diabetes, are major risk amplifiers for TB (Odds Ratios > 5).
• In Brunei, 33.9% of TB patients had diabetes, with older age, renal disease, and hypertension also significantly linked.
• SGLT2 inhibitors (e.g., dapagliflozin, empagliflozin) in diabetic TB patients showed substantial mortality reductions—up to 92% lower one-year mortality in high-dose users.
• Feasible interventions: Integrate diabetes screening and management in TB control programs. Investigate and consider off-label use or trials of SGLT2-i for comorbid TB-DM patients in high-burden areas.

See also: BMRC Indonesia

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3. Social Determinants & Stigma

• Stigma (internal and external) leads to delayed care, treatment dropouts, and isolation.
• Internal shame and societal rejection were consistent across Southeast Asian studies.
• TB is reinforced as a "disease of poverty", with low-income communities bearing the heaviest burdens.
• Feasible interventions: Design community-based anti-stigma campaigns and peer support systems. Tackle structural poverty and improve healthcare access as part of TB elimination strategies.

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4. Innovation Gaps in Diagnostics, Vaccines, and Surveillance

• Diagnostic and vaccine tools are decades outdated (e.g., BCG, Mantoux).
• WHO’s End TB goals are faltering—only 1.5% annual incidence reduction vs. 10% target.
• Promising tools: Xpert Ultra, QuantiFERON for better diagnostics. Genomic sequencing and PET/CT imaging show promise but are costly.
• Feasible interventions: Scale up use of WHO-recommended molecular diagnostics. Build national capacity for TB surveillance and genomics, especially in LMICs.

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5. Research, Policy, and System Reform

• Top-down global TB strategies need restructuring.
• Emphasis on local leadership, reduced red tape, and context-sensitive research models.
• Cohort studies (Brunei, Taiwan, Aceh) show the value of real-world, data-driven insights into localized TB risks.
• Feasible interventions: Support local TB program autonomy with funding and technical support. Encourage collaborative research hubs in high-burden regions. Align national policies with WHO’s integrated TBDM framework and climate-health surveillance insights.

Yoseph Leonardo Samodra

References:

1. Khairunnisa C, Mardiati, Millizia A, Wahyuni S, Nabilah Lubis P, Ikhsan M. Risk Factors for Pulmonary Tuberculosis Transmission Among Prisoner in Correctional Facilities in Lhokseumawe City, Aceh, Indonesia. Natl J Community Med 2025;16(6):582-588.
2. Pradana, T.L.C., Putra, B.T.W. and Utami, W.S., 2025. Stigma Tuberkulosis Paru di Asia Tenggara: Systematic Literatur Review. MAHESA: Malahayati Health Student Journal, 5(6), pp.2501-2512.
3. Syahrani, F., Lestari, H. and Irma, I., 2025. Faktor Risiko Kejadian TBC pada Usia Produktif di Puskesmas Poasia, Kota Kendari Tahun 2024. Jurnal Kendari Kesehatan Masyarakat, 4(3), pp.221-229.
4. Wright K. Tackling Tuberculosis: The Current Landscape and Future Directions. EMJ Microbiol Infect Dis. 2025;6[1]:26-30.
5. Lee, C.S., Ho, C.H., Liao, K.M., Wu, Y.C. and Shu, C.C., 2025. The impacts of SGLT2 inhibitors on the mortality of patients with tuberculosis. Journal of Infection and Public Health, p.102686.
6. Omar, N., Wong, J., Thu, K., Alikhan, M.F. and Chaw, L., 2021. Prevalence and associated factors of diabetes mellitus among tuberculosis patients in Brunei Darussalam: a 6-year retrospective cohort study. International Journal of Infectious Diseases, 105, pp.267-273.
7. Chaw, L., Liew, S.Q. and Wong, J., 2022. Association between climate variables and pulmonary tuberculosis incidence in Brunei Darussalam. Scientific Reports, 12(1), p.8775.

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