# Reframing TB Care: A Perspective on Multimorbidity-Centered Care for People with TB

## TL;DR

This paper suggests a new approach to TB care that addresses multiple health conditions together, especially in African health systems.

## Contribution

The paper introduces a phased framework for multimorbidity-centered TB care to improve treatment outcomes.

## Key findings

- TB is often accompanied by other conditions like HIV and diabetes, which worsen outcomes.
- Current TB care is fragmented and not well-equipped to handle multiple health issues.
- A three-phase framework is proposed to integrate TB care with other health services.

## Abstract

Tuberculosis (TB) rarely occurs in isolation; most people with TB experience multiple coexisting conditions, including HIV, diabetes, undernutrition, depression, and substance use disorders, which worsen disease severity and compromise treatment outcomes. Although the World Health Organization has issued disease-specific guidance for managing key comorbidities, TB care remains largely siloed and poorly equipped to address the growing burden of multimorbidity, particularly in African health systems. In this perspective article, we propose a phased framework for multimorbidity-centered TB care. The first phase emphasizes systematic screening for common comorbidities and establishment of basic referral pathways. The second phase focuses on strengthening coordination between TB programs and existing health and social services, including task sharing and longitudinal follow-up. The third phase advances toward fully integrated, co-located, multidisciplinary models of care that embed TB services within broader multimorbidity platforms. Together, this framework offers a pragmatic roadmap for TB programs to deliver more person-centered, equitable, and efficient care, strengthen primary care systems, and accelerate progress toward ending TB as a public health threat in Africa.