Tuberculosis Control in Vulnerable Populations
Summary
Tuberculosis remains a leading infectious killer worldwide, disproportionately affecting socially and economically marginalised groups. Populations deprived of liberty, homeless individuals, migrants, refugees, and those experiencing undernutrition or displacement face heightened exposure, delayed diagnosis and poorer treatment outcomes. Control efforts increasingly emphasise integrated approaches that combine active case finding, simplified diagnostic algorithms, short-course regimens and community-based support. Social determinants such as overcrowding, food insecurity, stigma and mental ill health undermine adherence and perpetuate transmission. Recent strategies stress the importance of intersectoral collaboration between health services, social welfare and justice systems to ensure continuity of care, nutritional supplementation and stable housing. Community health workers, peer support networks and mobile clinics have demonstrated success in improving case detection and treatment completion among high-risk groups. Achieving global targets for ending tuberculosis by 2035 will require tailored policies that address the specific barriers faced by vulnerable communities, reinforced by robust data systems to monitor equity in access and outcomes.
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Tuberculosis Control in Vulnerable Populations publication trend
The graph below shows the total number of articles in tuberculosis control in vulnerable populations across all publications each year (not limited to Nature Index journals).
Technical terms
Directly observed therapy short-course (DOTS): A treatment strategy in which a healthcare worker or trained supporter observes each medication dose to ensure adherence and prevent drug resistance.
Multidrug-resistant tuberculosis (MDR-TB): Disease caused by Mycobacterium tuberculosis strains resistant to at least isoniazid and rifampicin, the two most potent first-line drugs.
Latent tuberculosis infection (LTBI): A state in which individuals harbour Mycobacterium tuberculosis without clinical symptoms, detectable only by immunological tests and at risk of progression to active disease.
Case notification rate: The number of newly diagnosed and reported tuberculosis cases per 100 000 population in a given period, used to assess detection efficiency.
Sputum culture: Laboratory method for isolating Mycobacterium tuberculosis from expectorated respiratory samples, providing definitive diagnosis and drug susceptibility information.
References
- Early Release - Treatment Outcomes for Tuberculosis Infection and Disease Among Persons Deprived of Liberty, Uganda, 2020 - Volume 30, Number 7—July 2024 - Emerging Infectious Diseases journal - CDC. Emerging Infectious Diseases (2024).
- WHO’s end of TB targets: unachievable by 2035 without addressing under nutrition, forced displacement, and homelessness: trend analysis from 2015 to 2022. BMC Public Health (2024).
- Factors associated with unsuccessful tuberculosis treatment among homeless persons in Brazil: A retrospective cohort study from 2015 to 2020. PLOS Neglected Tropical Diseases (2023).
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