Improving Tuberculosis Treatment Outcomes in Somalia: A Narrative Review of Strategies, Challenges, and Policy Recommendations

Tuberculosis (TB) remains a major public health concern in Somalia, driven by prolonged conflict, population displacement, fragile health systems, and adverse social determinants of health. Although Somalia has made progress in expanding TB services and achieving favourable treatment outcomes for drug-susceptible TB, the country continues to experience a high TB burden and emerging drug-resistant tuberculosis (DR-TB). Persistent challenges include delayed diagnosis, treatment interruption, catastrophic patient costs, paediatric TB care gaps, and reliance on external donor funding. This narrative review synthesizes evidence from peer-reviewed articles, programmatic reports, and international guidelines to examine TB treatment outcomes, key challenges, and current strategies in Somalia. Literature was searched in PubMed, Google Scholar, and Scopus databases, as well as relevant grey literature from the World Health Organization and humanitarian organizations. Publications between 2010 and 2024 were considered, and 35 studies were identified, of which 15 met the inclusion criteria and were included in the final synthesis. The findings highlight the importance of decentralized and community-based care, rapid molecular diagnostics, multimodal adherence support, shorter all-oral DR-TB regimens, and integration of TB services with nutrition and humanitarian support. Strengthening health system resilience and prioritizing vulnerable populations are essential for sustaining improvements in TB treatment outcomes in Somalia and other fragile settings.