KEY DRIVERS OF HIGH TB BURDEN IN TOP 10 COUNTRIES: A SYSTEMATIC REVIEW

Tuberculosis (TB) is the second leading cause of death from infectious diseases globally, with 10.6 million cases and 1.3 million deaths, largely concentrated in India, Indonesia, China, the Philippines, Pakistan, Nigeria, Bangladesh, the Democratic Republic of the Congo, South Africa, and Myanmar, in 2022.This study aimed to identify key socioeconomic and environmental factors, assess TB-related healthcare and policies, and examine the impact of the COVID-19 pandemic in these countries. A systematic review was conducted by searching major databases for studies related to the key drivers of high TB burden. After screening 3,660 studies, 62 relevant papers were analyzed for inclusion in this review.Thematic analysis was employed to systematically identify, analyze, and interpret patterns within the data extracted from the selected studies. This approach enabled the categorization of key drivers and contextual factors contributing to the high TB burden, facilitating a comprehensive understanding of recurring themes across different settings.The review found that factors such as income loss, financial hardship, high out-of-pocket healthcare costs, and regional economic disparities significantly contribute to the TB burden, with comorbidities and poor sociodemographic conditions amplifying these challenges. Insufficient healthcare infrastructure, staffing shortages, and heavy reliance on external funding further weaken TB control efforts. Additionally, delayed diagnosis, limited access to quality healthcare services, stigma associated with TB, and low awareness about disease prevention were frequently identified as barriers. Political instability, population displacement, and gaps in treatment adherence also play critical roles in sustaining high TB rates in these countries.These findings can inform the development and implementation of integrated healthcare strategies, improvements in living conditions, and targeted interventions aimed at effectively reducing TB rates and addressing dual health burdens in high-prevalence settings.