Summary
Background: Tuberculosis (TB) continues to impose significant morbidity and mortality, with gender influencing access and outcomes within the TB care continuum. Despite international guidance and global commitments on gender-responsive TB care to improve the equity and effectiveness of the TB response, the extent to which gender is considered in TB strategies remains unclear. This scoping review aimed to collate and synthesize the evidence on gender-responsive TB interventions designed and implemented in low- and middle-income countries (LMICs) and high TB burden countries from 2000 to 2025.
Methods: The review followed the Joanna Briggs Institute’s scoping review guidelines, using the PRISMA-ScR framework for reporting. Studies were eligible if they described TB initiatives for adults aged ≥ 15 years, addressed access to services across the TB care cascade, written in English and explicitly mentioned gender considerations in their introduction, study aims and objectives, or methods sections, beyond sex-disaggregation of results. The search spanned multiple databases and included both peer-reviewed and grey literature. Quality assessment was done using the Crowe Critical Appraisal Tool (CCAT), and gender responsiveness was assessed using the WHO Gender Responsiveness Assessment Tool (GRAT).
Results: Although many TB initiatives reported sex-disaggregated results, most were not gender-responsive by design; thus, from 3878 identified studies, 15 met inclusion criteria. Gender responsiveness varied as two interventions did not consider gender differences, treating everyone the same (gender-blind), eleven indicated gender awareness but lacked proper remedial action (gender-sensitive), and two were designed to target and benefit a specific group of women or men (gender-specific). No studies were found to be gender unequal or gender transformative. Nine studies targeted their intervention towards both men and women, five towards women only, and one towards men only. CCAT scores ranged from 52.5% (moderate quality) to 95% (high quality).
Conclusion: This scoping review found limited consideration of gender in TB interventions, with most studies addressing gender superficially by including female healthcare workers or sex-disaggregated results without rigorous design, analysis, or proposed recommendations relating to the influence of gender norms on access to TB care. There remains a significant gap in gender-transformative TB programming which risks perpetuating disparities in access and health outcomes across genders which will challenge global commitments to ending TB.
Keywords: Gender equity; Gender transformative interventions; Person-centered care; Tuberculosis care cascade.
