POLICY BRIEF

Advancing the Fight against TB
Aligned with SDG 3 and WHO Goals

Tuberculosis (TB) remains one of the world’s top causes of infectious disease-related morbidity and mortality, with an estimated 10.6 million new cases and 1.3 million deaths in 2022. While TB is both preventable and curable, it disproportionately impacts low- and middle-income countries (LMICs, people living with HIV (PLHIV), and marginalized populations such as migrants, incarcerated individuals, and those experiencing homelessness. Drug-resistant TB (DR-TB) is a growing challenge, requiring longer, costlier treatment regimens. New tools, including shorter preventive and treatment regimens, molecular diagnostics, and digital adherence support, offer transformative potential, but access and uptake remain uneven. This Fast-Track Cities policy brief highlights key initiatives, five illustrative case studies, challenges, opportunities, and actionable recommendations at municipal, national, and regional levels.

National Strategic Plan for TB Elimination in India: India’s plan uses a “Detect-Treat-Prevent-Build” approach, with active case finding, universal drug susceptibility testing, private-sector engagement, and nutritional support for patients. It aims to achieve TB elimination by 2025, five years ahead of global targets, supported by national prevalence surveys to guide subnational actions (Central TB Division, Ministry of Health and Family Welfare, Government of India, 2023)

Integrated TB-HIV Service Delivery in South Africa: South Africa’s national TB program scaled up use of the Xpert MTB/RIF assay to provide rapid, same-day diagnosis of TB and rifampicin resistance, replacing slower smear microscopy. This transition improved detection rates and reduced time to treatment initiation, especially in high-burden districts. The expansion also allowed integration of TB testing with HIV services, streamlining patient pathways and reducing loss to follow-up. Investments in laboratory infrastructure and workforce training created spillover benefits for diagnosing other respiratory pathogens, including during the COVID-19 pandemic. (National Department of Health, South Africa, 2022)

Community Health Worker-Led Active Case Funding in Cambodia: Cambodia deployed community health workers (CHWs) to conduct door-to-door TB screening, sputum collection, and patient navigation in high-burden areas. This approach significantly increased case detection, particularly among vulnerable groups such as the elderly and people with disabilities. CHWs also provided treatment adherence support, nutritional counseling, and stigma reduction outreach, building trust within communities. The model demonstrated cost-effectiveness by reducing hospitalizations and leveraging existing community-based health infrastructure. (International Journal of Environmental Research and Public Health, 2021)

Digital Adherence and Contact Tracing Tools in Vietnam: Vietnam has piloted digital health tools such as SMS reminders and electronic medication monitors, alongside GIS-based contact tracing, improving adherence and case detection in high-burden provinces. The tools improved medication adherence and enabled more targeted follow-up by health workers. Data from these systems informed district-level program adjustments and resource allocation. The approach also laid a foundation for using digital health tools in other chronic disease management programs. (FHI 360, 2022)

Social Protection and TB Care Integration in the Philippines: Bangladesh piloted a nine-month, standardized short-course regimen for multidrug-resistant TB (MDR-TB), compared to traditional 18–24-month regimens. The shorter regimen achieved high cure rates and improved adherence while reducing program costs. Patients reported improved quality of life and fewer side effects, enhancing long-term engagement with the health system. Programmatic scale-up has informed global guidelines and inspired similar trials in other high-burden countries. (PLoS One, 2022)

TB control efforts face significant obstacles, beginning with underdiagnosis and delays in detection, particularly among rural, mobile, and marginalized populations who have limited access to timely testing. Many health systems have yet to achieve full integration of TB services with HIV care, primary health care, and social protection programs, leading to missed opportunities for comprehensive case management. Access to rapid molecular diagnostics and shorter treatment regimens remains uneven due to cost barriers, constrained supply chains, and inadequate procurement systems. Stigma and discrimination continue to discourage individuals from seeking care, while underfunding TB programs, especially in high-burden countries, limits the scale and sustainability of interventions. These factors compound the risk of ongoing transmission, drug resistance, and widening inequities in TB outcomes.

Despite these challenges, a range of opportunities exists to accelerate TB elimination. Scaling up universal access to rapid molecular diagnostics could enable earlier, more accurate detection of both drug-sensitive and drug-resistant TB, while national adoption of shorter, patient-friendly treatment regimens has the potential to improve adherence and outcomes. Embedding TB services within universal health coverage schemes and linking them to social protection measures can reduce the financial and social burden of illness. Digital health tools – including adherence monitoring devices, SMS reminders, and real-time surveillance systems – offer new pathways to improve treatment completion and program responsiveness. Strengthening community engagement can build trust, reduce stigma, and enhance demand for services, while sustained investments in innovation, workforce training, and integrated care models can help countries close the gap to TB elimination targets.