{"doi":"10.1002/jia2.26081","title":"New tricks for an old dog: opportunities for better tuberculosis control","abstract":"Tuberculosis (TB) remains an enigmatic disease. Consistently among the leading causes of annual global mortality, its impact is greatest in a limited number of high-burden countries, many of which are marked by poverty, stark internal inequalities, societal instability and, since the late 20th century, high HIV prevalence. An ancient disease which has plagued humanity for millennia, TB often defies definitive diagnosis, especially in those most at risk, such as children and people living with HIV, where presentation can be complicated owing to immature or deficient immune function. Declared a global emergency in 1993, TB struggles perennially to secure a position in the popular consciousness (in contrast to COVID-19), and consistently fails to attract the funds necessary to drive preventative and therapeutic interventions, as well as the research required to develop innovative new programmes [1]. Programmatic control and clinical management of TB require a deeper understanding of the complex interaction between the causative agent, Mycobacterium tuberculosis, and its obligate human host. TB control remains heavily dependent on the treatment of active disease, with the standard 6-month multidrug combination therapy posing a host of challenges for health systems, in conjunction with poor patient adherence. Key recent developments include innovations in composition and duration of combination therapies for both drug-susceptible and drug-resistant disease [2], and the potential to accelerate new regimen development through adaptive clinical trial design [3]. In addition, through the efforts of pioneering partnerships, such as the Tuberculosis Drug Accelerator [4], the pre-clinical pipeline for new TB drugs is stronger than ever [5], harnessing advanced technologies to address knowledge gaps, such as the distributions of anti-TB drugs into diverse anatomical compartments [6], and the optimal design of new combinations to reduce treatment durations and limit the development of drug resistance [7]. Effective therapy depends on knowledge of who is ill, and the development of improved point-of-care TB diagnostics remains a priority. Recent advances include expanding the GeneXpert molecular assay to detect multi-drug resistance [8], the use of whole-genome sequencing direct from clinical samples [9] and biomarker-based approaches to diagnose active disease [10]. Artificial-intelligence-based computer-aided detection systems for rapid digital X-ray diagnosis are also showing promise [11]. Novel technologies—not yet ready for widespread implementation—include the use of face-mask sampling [12] and the collection of breath aerosols [13]. The addition of newer, non-sputum-based diagnostics is critical to better define the TB disease state. Advancing new vaccines, to replace Bacille Calmette-Guérin for the prevention of infection or to prevent progression to disease, is essential to make realistic progress towards global TB control, and a comprehensive roadmap outlines how this might be accelerated, based on recent experience of multiple ambitious, high-profile endeavours [14]. Like drug development, these initiatives continue to benefit greatly from more complex models of M. tuberculosis infection and TB disease, such as those using non-human primates [15]. And what of the immediate future? Regaining ground lost to COVID-19 is critical but will not be easily achieved. There are, however, some encouraging signs suggesting lessons from that pandemic can be usefully applied to TB. For example, it was not long into the COVID-19 pandemic that the concept of subclinical SARS-CoV-2 infection was assimilated into mainstream thinking. It seems strange, therefore, that an analogous appreciation of the potential for subclinical—even asymptomatic—M. tuberculosis infection and transmission as major drivers of TB prevalence in high-burden settings has been so reluctantly adopted. There are some major uncertainties: what is the population-attributable pro","journal":"Journal of the International AIDS Society","year":2023,"id":403914,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9552,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":252299,"name":"Robin Wood","orcid":"0000-0002-4276-7117","position":1,"is_corresponding":false},{"id":403921,"name":"Digby F. Warner","orcid":"0000-0002-4146-0930","position":0,"is_corresponding":true}],"reference_count":20,"raw_metadata":null,"created_at":"2026-07-19T01:20:40.264741Z","pmid":"36951496","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}