Highlighting the work of Dr. Hmwe Hmwe Kyu and colleagues on World TB Day

World TB Day marks the anniversary of Dr. Robert Koch’s discovery of the bacterium that causes tuberculosis (TB) on March 24, 1882. Since then, giant strides have been made to eradicate this preventable and curable disease from the globe, but TB still kills more than 1 million people every year. That’s why educating the public and understanding the current impact of this disease remain crucial to improving global health outcomes. Studies from IHME are shining light on who is suffering from TB, where, and what interventions might help. In honor of World TB Day 2023, we asked IHME Assistant Professor Dr. Hmwe Hmwe Kyu to tell us more about her work on this ancient – but still very present – disease. 

What do you consider the most important findings of your most recent studies on TB?  

The burden of TB is larger among males than females in HIV-negative populations. Risk factors, especially smoking and alcohol use, contribute largely to the sex differences in the TB burden between males and females. 

The burden of TB is larger among females than males in HIV-positive populations, especially in sub-Saharan Africa. HIV itself is a strong risk factor for TB, and unsafe sex and intimate partner violence are key HIV risk factors in females. 

Did anything in your studies surprise you? 

An interesting finding is that HIV-TB coinfection is more common in females than males in many countries in sub-Saharan Africa, but the opposite is true for most of the countries outside of sub-Saharan Africa. 

What do you wish more people understood about TB and the efforts to reduce death and illness from this disease? 

Although TB-related mortality has decreased over time, unnecessary deaths could be further prevented by interventions to improve case detection, promote early diagnosis and treatment, and reduce exposure to the TB risk factors. For example, active case finding programs in Cambodia that targeted districts with high poverty rates and TB prevalence have been shown to reduce the TB burden.  

In general, efforts to reduce death and illness from TB are more likely to be successful if they are tailored to setting-specific needs. In Myanmar, for example, TB services were provided for free, and there was decentralization of anti-TB medications to rural health centers, but a lack of diagnostic capacity in villages meant that patients who couldn’t travel to a facility with the necessary diagnostic equipment wouldn’t be diagnosed. Efforts to curb the TB burden are likely to achieve much better outcomes if one-stop services that include diagnosis, treatment, risk factor screening, and management could be provided. 

What does the future of your TB research look like? Do we have more studies to look forward to in the coming year? 

There remain unanswered questions regarding the impact of the COVID-19 pandemic on TB. For example, what is the net effect of reduced transmission due to mask use and social distancing and increased transmission due to delayed diagnosis and treatment due to service disruption? In this recent paper, we aimed to examine the contribution of COVID-19 mitigation measures in explaining the difference between the expected TB cases reported in Indian states and the actual number reported during the pandemic and discussed implications for future research.