Targeting men's TB treatment could cut tuberculosis across Africa

Tuberculosis (TB) is not spread evenly: worldwide, men carry a heavier burden than women and children, with gaps at every stage from exposure to diagnosis and treatment. Alexandra S Richards and colleagues set out to understand how much of the lingering TB problem could be eased by concentrating on those gaps in men. To do that, the researchers built a mathematical model that simulates how TB spreads and how people move through stages of infection, disease, care, and recovery. The model included separate groups by sex and age, and accounted for the effects of HIV and antiretroviral therapy, because those factors influence TB risk. The team calibrated the model to each country’s data on TB prevalence, incidence, deaths, and case notifications from 2010 to 2022 in four countries: Kenya, Malawi, Nigeria, and Uganda. They then used the model to test what would happen if health systems increased how many men with TB get treatment, and if social and structural factors that make men more susceptible to TB were reduced.

The study used a deterministic transmission model to compare strategies and projected outcomes to 2035 for incidence and mortality, and to 2025–2030 for case notifications. Increasing treatment coverage among men produced measurable reductions in overall TB incidence, but the size of the effect varied by country: relative reductions ranged from 4.8% (95% uncertainty interval, UI, 0.7–10.6%) in Malawi to 24.8% (UI 14.3–37.0%) in Uganda. Addressing the excess risk that men face produced similar overall effects, with reductions from 8.4% (UI 6.6–10.4%) in Nigeria to 23.3% (UI 18.0–30.0%) in Uganda. When both strategies were combined the reduction in incidence was larger than either strategy alone, though not as large as simply adding the two separate effects together—because preventing new cases reduces the pool of people needing treatment. Benefits were not limited to men: median country-level declines in incidence across the four countries were between 1.6% and 10.6% for women and between 2.8% and 19.5% for children. Increasing men’s treatment coverage raised notifications by a median 3.1% to 12.4% in the first three years, but when higher treatment coverage was paired with reduced risk, median annual notifications fell by 6.7% to 18.1% by 2035.

These findings point to a practical way to reduce TB that can reach beyond the men directly targeted. Prioritising better case-finding and treatment access for men, and tackling the social and structural drivers that make men more likely to develop TB, could lower infections and deaths for men, women, and children. The results varied by country and scenario, so local data and context will matter when designing programs. Combining improved treatment coverage with prevention of men’s excess risk gave the biggest population-level benefits, showing that mixed approaches—both treating current cases and preventing new ones—are complementary. The authors conclude that gender-responsive TB strategies are essential to make care more person-centred and to speed progress toward global End TB targets. In short, focusing on men’s TB needs is not only fairer, it could be one of the more effective ways to reduce TB overall.