Global Variation in National Tuberculosis Guidelines: A Scoping Review

BACKGROUND: Tuberculosis (TB) remains a leading cause of infectious mortality worldwide, with primary care playing a central role in early detection, treatment, and prevention. The World Health Organization (WHO) End TB Strategy provides a global framework for TB control, but its implementation varies across national guidelines. METHODS: We conducted a scoping review of national and international TB guidelines published between 2015 and 2025. A systematic search of databases and grey literature identified relevant documents. Guidelines were analysed across key domains of TB management, including screening, diagnosis, treatment, preventive therapy, treatment monitoring, and HIV/TB coinfection. Countries were classified as high- or low-incidence settings based on WHO incidence thresholds. RESULTS: 76 guideline documents from 34 countries and international organisations were included. Overall, strong alignment with WHO standards was observed for core clinical practices such as diagnosis and treatment regimens. However, substantial variation was identified in case-finding strategies, latent TB infection (LTBI) management, treatment monitoring, and HIV/TB service integration. High-incidence countries prioritised active case finding to reduce transmission, whereas low-incidence countries emphasised targeted screening and preventive therapy. Conclusions: While clinical management of TB is broadly standardised, variation in guideline implementation reflects differences in epidemiology and resource availability. Addressing structural barriers and supporting context-specific implementation will be essential to optimise TB control and improve outcomes across diverse settings.