Building Social Equity and Person-Centred Innovation in the Global End TB Response

Tuberculosis (TB) prevails most in LMICs and socially marginalized groups in higher-income countries. Airborne transmission means that it most affects people who live and work in  overcrowded conditions, many of whom are  financially disadvantaged, or are migrants, refugees, prisoners, and the homeless. Its etiology renders it most common among immunocompromised individuals such as those living with HIV, diabetes, and malnutrition, and those who use tobacco and alcohol, conditions also associated with socioeconomic vulnerability. However, social, structural, and economic drivers of disease – that raise questions of social and ethical relevance – are often ignored–. TB needs to be comprehensively addressed, and person-centred, equity-oriented approaches to TB care, that draw on the values of shared decision-making and self-determination, need to be universally applied across the TB care cascade, to substantially reduce the burden of disease.

To provide such a reorientation on TB, a SSHIFTB workshop titled “Building Social Equity and Person-Centred Innovation in the Global End TB Response” was held at Brocher Foundation in Geneva from November 20-22, 2023. The workshop brought together individuals from various fields, such as social scientists, TB-affected community members, policymakers, funders, and technical agencies, to critically examine proposed approaches, operationalization mechanisms, and funding schemes to achieve person-centred care and equity. Another key aim was to develop a social science research agenda for TB that is centred on equity. A total of 26 participants from across the globe attended the three-day workshop, with representatives from global agencies such as WHO, GFATM, Stop TB Partnership, ILO, and FIND joined the dialogue also joining on the third and final day.

The workshop focused on the inequity problem in TB, exploring various disciplinary lenses, identifying different forms of equity at play, and discussing metrics for equity. It also discussed social science-inspired solutions, delving into interventions across diverse domains, the relationship between social sciences, equity, and communities, and the intersection of equity and financial considerations—the workshop’s final day to create space for social sciences in TB decision-making.

This workshop aimed to disrupt the mainstream TB scientific discourse by focusing on TB as a social inequity problem. The anticipated outcomes of the workshop are far-reaching. The participants envisioned a future where TB policy and programming are framed with a clear focus on equity. Among the expected outcomes were a critical review of global TB policies, identification of equity and person-centred TB care exemplars, and the development of new research questions and methodologies. The workshop also aimed to establish strategies for systematizing social science evidence and creating a platform for interdisciplinary knowledge sharing.

In conclusion, the SSHIFTB workshop successfully navigated the complexities of TB as a social inequity problem. By fostering direct discourse among public health professionals, donors, social scientists, the TB-affected community, TB practitioners, and global agencies, the workshop set the stage for a critical research agenda. The collaborative efforts initiated during these three days are poised to drive transformative changes, paving the way for a more equitable TB care system on a global scale. The workshop was supported by two grants from the Brocher Foundation and an SSHRC connection grant.