ArticleThe Lancet. Global health2025
Implications of progressive lung damage and post-tuberculosis sequelae for the health benefits of prompt tuberculosis treatment in high HIV prevalence settings: a mathematical modelling analysis.
Article in The Lancet. Global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2 citing papers in PubMed.
- Association between tuberculosis diagnosis delay and respiratory health and well-being among tuberculosis survivors in Cambodia: a prospective cohort study.BMJ open respiratory research · 2026Article
- The health impact of identifying a person with tuberculosis through systematic screening.The Lancet. Infectious diseases · 2025Review
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Abstract
backgroundUntreated pulmonary tuberculosis causes ongoing lung damage, which can persist after treatment. Conventional modelling approaches for assessing tuberculosis health effects might not fully capture these mechanisms. We evaluated how tuberculosis-associated lung damage and post-tuberculosis sequelae affect the lifetime health consequences of tuberculosis in high HIV prevalence settings.
methodsWe developed a microsimulation model (computer simulations that reproduce disease natural history and intervention effects for sampled individuals) representing dynamic changes in lung function for individuals evaluated for tuberculosis in routine clinical settings. We parametrised the model with data (from a previously published study) for three African countries with a high burden of tuberculosis and HIV: Uganda, Kenya, and South Africa, and estimated lifetime health outcomes under prompt, delayed, and no tuberculosis treatment scenarios. We compared results to earlier modelling approaches that omit progressive lung damage and post-tuberculosis sequelae.
findingsWe estimated a 5·1 years (95% uncertainty interval 3·8-6·4) reduction in life expectancy due to tuberculosis with prompt treatment, 7·7 years (5·5-10·1) with delayed treatment, and 18·5 years (15·5-20·6) with no treatment. Estimated per-person disability-adjusted life-years (DALYs) from tuberculosis were 11·4 years (8·9-14·2) with prompt treatment, 17·1 years (13·1-22·1) with delayed treatment, and 37·7 years (34·3-40·3) with no treatment. Compared with individuals without HIV, individuals with HIV had a greater proportion of tuberculosis-attributable deaths, but fewer life-years lost to tuberculosis. Post-tuberculosis DALYs represented 52·5% of total DALYs with prompt treatment, 42·7% with delayed treatment, and 9·1% with no treatment. Modelling approaches that omit progressive lung damage and post-tuberculosis sequelae underestimated lifetime health losses of tuberculosis by 48-57% and underestimated the benefits of prompt treatment by 45-64%.
interpretationDelayed initiation of tuberculosis treatment causes greater lung damage and higher mortality risks during and after the disease episode than prompt treatment. In settings with coprevalent tuberculosis and HIV, accounting for these factors substantially increased estimates of the lifetime disease burden and life expectancy loss caused by tuberculosis. These findings imply greater health effects and cost-effectiveness for interventions to prevent tuberculosis and achieve earlier treatment initiation than indicated in previous analytical approaches.
fundingUS National Institutes of Health.
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