The evidence on determinants, burden and program outcomes of tuberculosis: A scoping review

Tuberculosis (TB) remains one of the world’s leading causes of infectious disease mortality, with progress toward elimination targets lagging despite the implementation of the End TB Strategy. Persistent social determinants, comorbidities, drug resistance, and programmatic challenges continue to undermine control efforts, particularly in low- and middle-income countries. To systematically map existing evidence, we conducted a scoping review guided by the Arksey and O’Malley framework, refined by Levac et al., and reported according to PRISMA-ScR. Comprehensive searches of PubMed, Scopus, and ProQuest identified studies published between January 2015 and December 2024 in English and Indonesian, including observational research, surveillance reports, and program evaluations. From 1,126 records, 22 studies met inclusion criteria. The evidence demonstrated that TB is shaped by complex determinants: sociodemographic factors such as male sex, poverty, and low education; behavioral risks including smoking, alcohol use, and adherence medication; nutritional vulnerabilities such as vitamin D deficiency and malnutrition; comorbidities including HIV, diabetes, and hepatitis B; and environmental exposures like overcrowding and poor ventilation. Several studies also emphasized the contribution of host genetic polymorphisms and immune responses, adding a biological layer to TB susceptibility. Burden analyses highlighted high incidence in vulnerable groups, geographic disparities, and ongoing transmission of drug-resistant strains, with multidrug-resistant and rifampicin-resistant TB persisting as critical threats. Program evaluations generally reported treatment success rates above 80% but identified gaps in preventive therapy, delays in diagnosis, under detection, and weak TB–HIV service integration. Evidence also indicated that contact tracing remains inconsistent and uptake of preventive therapy for children and high-risk contacts is low, while community-based models of care were associated with better adherence and outcomes. Collectively, these findings underscore the need for integrated, multisectoral strategies that extend beyond pharmacological treatment to address underlying social and structural drivers of TB, while future research should prioritize longitudinal designs, explore nutritional and immunological interventions, and examine the effects of climate change, migration, and health system resilience on TB epidemiology to accelerate progress toward global TB elimination.