Each year, over 10 million people worldwide contract tuberculosis (TB). The progression from infection to active disease is influenced by various factors, including socioeconomic status (poverty, malnutrition, overcrowded living conditions, occupational hazards such as of miners or health care workers), age and life stage (older adults are particularly vulnerable, while children face challenges in receiving accurate diagnoses), geographic disparities (urban vs. rural healthcare access, remote areas, migration and displacement), health system barriers (bias in health care, unequal distribution of TB diagnostics and treatments), intersectionality and other co-factors (HIV/AIDS impact, diabetes, stigma and discrimination, legal and policy barriers for certain groups), and biological and social differences (higher prevalence in men, higher stigma in women).
Effectively reaching these vulnerable groups and addressing demographic disparities are essential to ending the TB epidemic. The UN High-Level Meeting’s political declaration outlines commitments to finding and treating TB in both adults and children, while the Global Plan to End TB sets ambitious 90-(90)-90 targets. The middle “90” represents reaching 90% of those in need of treatment and prevention, with a focus on TB vulnerable groups. Achieving these targets requires addressing all barriers that limit access to essential TB services.
For instance, men are disproportionately affected by TB in many countries. To effectively reach them, it is crucial to provide targeted information, screening, testing, and treatment services in the places they live, work, and socialise. Women, on the other hand, face distinct challenges in the TB response. They often serve as primary caregivers for those with TB, whether as healthcare professionals or within their families. Pregnant women with TB require specialised interventions to safeguard both maternal and child health. Additionally, TB-related stigma disproportionately impacts women, often leading to devastating consequences such as divorce, homelessness, and social exclusion.
To address these challenges, policies and programs must be focused on the needs of vulnerable groups, ensuring that all have access to the quality care and support they need. Understanding the factors driving increased exposure, limited healthcare access, and weakened immunity is essential for tailoring TB interventions. To design effective TB interventions, it is essential to:
- Identify and quantify TB vulnerable groups, ensuring their inclusion in national and global TB strategies.
- Analyze data gaps and assess the barriers that hinder these groups from accessing prevention, diagnosis, treatment, and care services.
- Examine how treatment outcomes vary among these populations and develop targeted interventions to address their specific needs.
- Integrate these interventions, investments, and monitoring and evaluation (M&E) mechanisms into TB National Strategic Plans.
Meaningful participation from TB vulnerable groups is fundamental to building the knowledge and capacity needed for effective and sustainable TB responses. These communities must be engaged as active partners in the fight against TB, ensuring that strategies reflect their lived experiences and directly address the challenges they face.
