Progress, Challenges, and the Role of Socioeconomic Factors

• Global Impact & Incidence: TB remains the top infectious killer among adults, with over 10 million new cases annually. Progress varies across countries, with some achieving improvements while others struggle with health system frailties and limited investment.

• Key Challenges:

  • Inadequate case finding and diagnosis, especially in high-burden countries.

  • One-size-fits-all approaches and under-resourced health systems.

  • Two-thirds of TB deaths occur in just eight countries, particularly in India, Indonesia, and Nigeria.

• Diagnostic Advances:

  • Adoption of rapid molecular tests (e.g., Xpert MTB/RIF) and genome sequencing is limited by regulatory, cost, and infrastructure barriers.

  • Promising tests like tongue swabs and urine-based antigen tests are underutilized.

  • Digital health tools and AI-assisted x-ray readings offer potential for better case finding.

• Treatment Innovations:

  • New drug regimens (e.g., 4-month 4HPMZ for drug-susceptible TB and 6-month regimens for drug-resistant TB) enhance treatment adherence.

  • Shorter preventive regimens like 3HP are promising but limited by drug availability (e.g., rifapentine).

• Socioeconomic Influences: Poverty, overcrowding, and poor living conditions perpetuate TB’s high incidence in low-income populations.

  • Economic indicators (GDP, healthcare capacity) negatively correlate with TB incidence.

  • High-burden countries need support to address debt and funding shortfalls.

• Preventive Measures:

  • The BCG vaccine, while effective for children, has limited adult efficacy. New vaccines could greatly reduce treatment costs.

  • Addressing social determinants (e.g., air pollution, malnutrition) and providing nutritional support for TB patients are essential.

• Patient-Centered & Multisectoral Approaches: WHO advocates for people-centered care, including socioeconomic support and cross-sectoral collaborations, to improve TB outcomes and reduce barriers.

• India’s Unique Burden:

  • Significant TB burden, especially MDR and XDR-TB, driven by malnutrition, pollution, and latent TB reactivation.

  • Public sector care offers better outcomes; however, 1/3 of cases are lost to follow-up.

  • New diagnostic technologies (TrueNat, CB-NAAT) are more sensitive but face infrastructure and cost challenges.

• Economic Impacts of TB: Investing in TB programs yields high societal returns, with substantial benefits expected from reduced incidence and mortality.

• Role of Major Funders: Global Fund, USAID, and private providers play a key role in scaling diagnostics in underserved regions, with economic constraints influencing the adoption of new regimens in low-resource settings.

• Sources:

1. Reid, M., Agbassi, Y.J.P., Arinaminpathy, N., Bercasio, A., Bhargava, A., Bhargava, M., Bloom, A., Cattamanchi, A., Chaisson, R., Chin, D. and Churchyard, G., 2023. Scientific advances and the end of tuberculosis: a report from the Lancet Commission on Tuberculosis. The Lancet, 402(10411), pp.1473-1498.

2. Furin, J., Cox, H., & Pai, M. (2019). Tuberculosis. Lancet (London, England), 393(10181), 1642–1656.

3. Khanna, A., Saha, R. and Ahmad, N., 2023. National TB elimination programme-what has changed. Indian Journal of Medical Microbiology, 42, pp.103-107.

4. Dye, C., Garnett, G.P., Sleeman, K. and Williams, B.G., 1998. Prospects for worldwide tuberculosis control under the WHO DOTS strategy. The Lancet, 352(9144), pp.1886-1891.

5. Sorokina, M., Ukubayev, T. and Koichubekov, B., 2023. Tuberculosis incidence and its socioeconomic determinants: developing a parsimonious model. Annali di Igiene, Medicina Preventiva e di Comunita, 35(4): 468-479.

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