Quantifying Persistent Gaps in Tuberculosis Control in Low- and Middle-Income Countries: A Public Health and Policy Analysis
1
Public Health, Maharajgunj Medical Campus Institute of Medicine Tribhuvan University, Kathmandu, Nepal
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Tuberculosis (TB) remains a leading cause of infectious disease mortality, accounting for approximately 10 million incident cases and over 1.3 million deaths globally each year, with the majority occurring in low- and middle-income countries (LMICs). Despite scalable diagnostics and standardized treatment regimens, progress toward End TB targets has stagnated, highlighting the need for data-driven public health and policy responses.
METHODS:
We synthesized epidemiological data from global surveillance reports, national TB program indicators, and peer-reviewed studies published between 2005 and 2025. Quantitative outcomes included TB incidence, case detection rates, treatment success, multidrug-resistant TB (MDR-TB) prevalence, and catastrophic health expenditure. Policy and system-level interventions were analyzed in relation to program performance indicators.
RESULTS:
Across LMICs, TB incidence declined by less than 2% annually prior to 2020, followed by a documented 10–20% reduction in case notifications during the COVID-19 pandemic. Treatment success rates ranged from 75–85% for drug-susceptible TB, falling below global targets, while MDR-TB treatment success remained under 60%. Up to 50% of TB-affected households experienced catastrophic health costs despite nominally free TB services. Countries implementing decentralized molecular diagnostics, community-based active case finding, and integrated TB–HIV care demonstrated higher case detection and treatment completion rates compared with facility-based, passive models.
CONCLUSIONS:
Quantitative evidence indicates that TB persistence in LMICs is driven primarily by health system and policy failures rather than limitations of available medical tools. Strengthening primary care–based TB services, expanding social protection mechanisms, and embedding TB indicators within universal health coverage frameworks are critical to accelerate progress. Policy alignment across health, social welfare, and labor sectors is essential to achieving equitable and sustainable TB control.
Tuberculosis (TB) remains a leading cause of infectious disease mortality, accounting for approximately 10 million incident cases and over 1.3 million deaths globally each year, with the majority occurring in low- and middle-income countries (LMICs). Despite scalable diagnostics and standardized treatment regimens, progress toward End TB targets has stagnated, highlighting the need for data-driven public health and policy responses.
METHODS:
We synthesized epidemiological data from global surveillance reports, national TB program indicators, and peer-reviewed studies published between 2005 and 2025. Quantitative outcomes included TB incidence, case detection rates, treatment success, multidrug-resistant TB (MDR-TB) prevalence, and catastrophic health expenditure. Policy and system-level interventions were analyzed in relation to program performance indicators.
RESULTS:
Across LMICs, TB incidence declined by less than 2% annually prior to 2020, followed by a documented 10–20% reduction in case notifications during the COVID-19 pandemic. Treatment success rates ranged from 75–85% for drug-susceptible TB, falling below global targets, while MDR-TB treatment success remained under 60%. Up to 50% of TB-affected households experienced catastrophic health costs despite nominally free TB services. Countries implementing decentralized molecular diagnostics, community-based active case finding, and integrated TB–HIV care demonstrated higher case detection and treatment completion rates compared with facility-based, passive models.
CONCLUSIONS:
Quantitative evidence indicates that TB persistence in LMICs is driven primarily by health system and policy failures rather than limitations of available medical tools. Strengthening primary care–based TB services, expanding social protection mechanisms, and embedding TB indicators within universal health coverage frameworks are critical to accelerate progress. Policy alignment across health, social welfare, and labor sectors is essential to achieving equitable and sustainable TB control.
| eISSN: | 2654-1459 |
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