By Henry Neondo
Scientists and health stakeholders are calling for African health systems to move beyond TB treatment and provide integrated long-term care for survivors facing post-tuberculosis lung disease and other lasting health and socioeconomic effects.
Completing tuberculosis treatment may not always mean the end of illness for survivors, as health experts increasingly call for national health systems in sub-Saharan Africa to integrate care for post-tuberculosis lung disease and other long-term complications.
Post-tuberculosis lung disease (PTLD) can leave survivors with persistent respiratory problems, including chronic cough, breathlessness, wheezing, abnormal lung function and recurrent respiratory infections. Evidence suggests that a substantial proportion of people who successfully complete pulmonary TB treatment continue to experience lung damage and other health problems.
A study examining stakeholder perspectives in Kenya and Malawi found broad recognition of the need to look beyond the traditional TB treatment endpoint and provide longer-term, patient-centred care.
The research by a team led by Yochanan Hoppenstein, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, involved TB survivors, healthcare workers, policymakers, researchers, funders and representatives of national TB programmes. Forty-seven key stakeholders were identified, with 38 participating in interviews, while 59 stakeholders subsequently participated in country-level workshops.
The findings point to a major gap in the way TB programmes have traditionally been organised.
“Cure” has generally marked the end of formal TB care, with national programmes concentrating on diagnosing the disease, providing treatment and preventing transmission. However, researchers say this approach can leave some survivors struggling with chronic respiratory problems, psychological distress, stigma, loss of income and other consequences of the disease.
The stakeholders interviewed for the study supported a more holistic approach that addresses the physical, psychological, social and economic effects of TB.
Beyond the lungs
The researchers found that post-TB care cannot be limited to respiratory medicine alone.
Stakeholders identified a range of services that could be needed by TB survivors, including health education, counselling and psychological support, nutritional assistance, social support, vocational training, financial assistance, respiratory care and physiotherapy.
There was also recognition that TB survivors may have other conditions requiring attention, including HIV, diabetes, smoking-related disease, alcohol-use disorders and chronic respiratory diseases such as chronic obstructive pulmonary disease.
This means that post-TB care could require closer collaboration between national TB programmes, non-communicable disease programmes, HIV services, hospitals, primary healthcare facilities and community-based services.
The researchers found, however, that integrating these services presents significant challenges.
Among the concerns raised were uncertainty over who should lead post-TB services, inadequate funding, shortages of appropriately trained healthcare workers, limited diagnostic equipment and insufficient local data on the scale of post-TB disease.
In resource-constrained settings, access to tools such as spirometry and chest X-rays can also be limited, particularly outside major hospitals.
Who should take responsibility?
One of the most difficult questions emerging from the stakeholder discussions was where responsibility for post-TB care should sit.
Some stakeholders argued that national TB programmes should lead because they already have systems for identifying, treating and monitoring TB patients. Keeping post-TB services within these programmes could also provide continuity from diagnosis through treatment and recovery.
Others questioned whether TB programmes have the mandate, staff and technical capacity to manage the wider health, social and economic needs of survivors.
The study therefore points towards an integrated model in which TB programmes provide leadership while working with other health programmes and community services.
Patient advocates also stressed that post-TB disease should not be treated simply as a medical problem. Survivors may require support to deal with stigma, reduced ability to work, psychological challenges and the economic consequences of prolonged illness.
Africa begins to move towards integration
The debate identified by the study is increasingly reflected in policy and programme developments across Africa.
In 2024, the Global Fund reported that Kenya, Malawi, Tanzania and Uganda had begun work to integrate PTLD into the TB continuum of care. The initiative brought together national TB programmes, health institutions and implementing partners to address the burden of disease following TB treatment.
The Global Fund estimates that approximately 40 percent of people treated and cured of TB develop persistent PTLD symptoms, including breathlessness, chronic cough, wheezing and recurrent lung infections.
More recent evidence suggests that integration into national guidelines remains uneven.
A 2025 scoping review of national TB guidelines in high-burden countries found that only seven of 33 countries reviewed—21 percent—mentioned post-TB lung disease in their national guidelines. The countries identified included the Democratic Republic of Congo, Kenya, Malawi, South Africa, Uganda and Zambia, alongside Peru outside Africa.
Kenya, meanwhile, has moved further towards formal integration. Its National Integrated Lung Health Guideline includes PTLD among priority chronic respiratory conditions and provides recommendations for prevention, diagnosis, treatment and long-term management of lung conditions.
From TB cure to long-term lung health
The growing attention to PTLD reflects a broader shift in thinking about what constitutes successful TB care.
A 2024 editorial in IJTLD Open, published by The Union, noted that approximately one-third of people surviving pulmonary TB develop PTLD. The condition can include bronchiectasis, fibrosis, pleural thickening, cavitation and other forms of lung damage.
The same editorial argued that national TB programmes and professional societies need locally appropriate guidelines for diagnosing and managing TB sequelae.
For sub-Saharan Africa, the challenge is therefore no longer only to find and cure people with TB, but also to ensure that those who survive the disease do not disappear from the health system once treatment ends.
Researchers and stakeholders say this will require better data on the long-term health of TB survivors, clear clinical guidelines, sustainable financing, trained health workers and stronger links between TB, chronic respiratory disease, HIV and other health services.
For millions of African TB survivors, the message is increasingly clear: the end of TB treatment may be the beginning of a new phase of care—not necessarily the end of their health journey.
neondohenry@yahoo.com