Summary
Background: Globally, the burden of tuberculosis falls more on men than women and children, and there are large gaps between men and women at all stages of exposure, disease incidence, and treatment. We examined the impact of addressing determinants of these gender gaps in Kenya, Malawi, Nigeria, and Uganda.
Methods: We created a deterministic transmission model of tuberculosis, calibrated to country-specific data on prevalence, incidence, mortality, and notifications between 2010 and 2022. We examined the potential epidemiological impact of strategies to increase treatment coverage among men and decrease the effects of social and structural determinants that increase men’s risk of developing TB. We investigated the impact (overall and by age and sex) on projected incidence and mortality in 2035, and notification rates between 2025 and 2030.
Results: Our modelling estimates that increasing treatment coverage among men could reduce incidence in 2035 between 2.4% [95% uncertainty interval (UI) 0.2-6.0%] in Malawi and 23.0% [UI 16.8-29.3%] in Nigeria. Reducing men’s excess risk of tuberculosis could similarly reduce incidence in 2035 between 9.8% [UI 7.5-12.6%] in Malawi and 30.1% [UI 24.1-40.5%] in Kenya. Impacts extend across the population with median estimates of country-level declines in incidence of between 0.9-17.8% and 1.4-22.2% in women and children, respectively, across the four countries.
Conclusions: Strategies that prioritise increasing tuberculosis treatment coverage among men and mitigating men’s higher susceptibility to tuberculosis could reduce disease burden for men, women, and children. Such gender-responsive strategies are essential to ensure a person-centred tuberculosis response and accelerate global progress towards the EndTB targets.
Plain language summary
Globally, more men have tuberculosis than women or children, due to factors such as difficulty accessing care and increased exposure to risk factors such as high levels of alcohol consumption and tobacco smoking. We focussed on four countries, Kenya, Malawi, Nigeria, and Uganda, and built a mathematical model to understand the impact of increasing men’s access to diagnosis and treatment and the impact of reducing men’s exposure to risk factors. We found that strategies that focus on men not only reduce tuberculosis in men, but also across the entire population.
