Bridging the gender gap in TB care

Discussions on women's health often focus on sexual, reproductive, or maternal health, overshadowing disparities in other areas. Tuberculosis (TB) is a prominent example of this oversight, as one of the top five leading causes of mortality among adult women. Women are also more likely to develop extra-pulmonary TB and TB-HIV co-infection. The challenge is further exacerbated by underreporting and underdiagnosis of TB in women, with only one woman being diagnosed with TB for every two men. Women are also less likely to seek out diagnosis due to unequal social and economic status and greater social and self-stigma.

Addressing these challenges requires a targeted approach. The National Framework for a Gender-Responsive Approach to TB, under the National TB Elimination Programme (NTEP), outlines a gender-transformative strategy to ensure equity in TB interventions. For example, it recommends active TB screening among pregnant women living with HIV, who face a 400% increased risk of maternal and infant mortality. An effective way to do this is to integrate TB screening with reproductive, maternal, and child health initiatives.

Workplaces can play a crucial role in increasing women’s access to TB care by incorporating gender-inclusive policies. Employer-led, gender-sensitive TB interventions can improve prevention, diagnosis, and treatment for all employees, particularly benefitting women who might otherwise encounter barriers to care. The NTEP’s ‘TB-Free Workplace’ strategy engages employers across sectors to conduct regular screening for active TB. This approach is especially valuable for women-dominant workplaces with higher TB vulnerability, such as tea plantations, cotton mills, and handlooms. Proactive screening in these settings can enable early detection and diagnosis among women.

Tuberculosis Preventive Treatment (TPT) has also emerged as an important strategy in fostering a gender-sensitive approach towards TB elimination. TPT targets TB infection (TBI), the dormant form of the disease which can develop into active TB when the immune system is under stress. A successful example of implementing TPT is the Joint Effort for Elimination of TB (JEET) 2.0 (2021–2024) project supported by organisations like FIND. Based on India’s guidelines for TPT, household contacts of persons with TB were screened for active TB and those with TBI were initiated on preventive therapy. The project delivered preventive treatment to more than 100,000 women, demonstrating the effectiveness of TPT in combating TB and addressing TB related stigma, especially amongst women.

Investing in new and emerging technologies can improve TB detection among women, by providing quicker, more accurate results and reducing the need for multiple clinic visits. For example, ultraportable X-rays and AI-enabled reporting and teleconsultation can be leveraged to screen women in communities, overcoming the barriers they may face related to mobility.

Besides improving access to diagnosis and treatment, we must strengthen support systems that address harmful gender norms around TB, to ensure comprehensive diagnosis and care. The TB champions initiative, led by REACH and FIND, is an important move in this direction, empowering TB survivors to drive change in their communities by offering counselling, linking individuals with symptoms to care and helping persons with TB take charge of their health through treatment literacy. Women TB champions are uniquely positioned to help women with TB navigate personal, professional, social, and structural challenges to diagnosis and treatment. For example, women often struggle to meet the nutritional requirements for TB treatment as there is no one to care for them. TB champions can provide women with TB information about the financial assistance available for their nutritional needs under the Government's Nikshay Poshan Yojana (NPY) and counsel women’s families on the importance of nutrition in treatment success.

Investing in women's health is not just a humanitarian imperative, it is also a crucial driver of economic and social progress. A report by the World Economic Forum and the McKinsey Health Institute highlights that investing in women’s health could boost the global economy by $1 trillion by 2040 and lead to fewer early deaths and health conditions, and increased productivity. India has made tremendous progress against TB, achieving an 18% decrease in TB mortality and a 16% reduction in TB incidence in 2022 compared to 2015, nearly double the global rate of decline in TB incidence, which stands at 8.7%. By strengthening gender-responsive initiatives to address TB, India can advance gender parity and set a precedent for investing in women's healthcare, paving the way for a healthier, more equitable future.

This article is authored by Vinita Sethi, board member, FIND, India and chief corporate affairs officer, Apollo Hospitals group.