Cured but not healed: high burden of pulmonary disability and multimorbidity among TB survivors in India

SETTING Five districts across five states of India. OBJECTIVE To assess the prevalence of TB-associated disability, comorbidities, risk determinants, and linkage to care among adults completing TB treatment between October 2024 and December 2025. DESIGN A cohort study using primary data collection. Trained research staff conducted all the assessments. Pulmonary disability meant impaired lung function on spirometry and/or walking <400 m on 6-minute walk test. Linkage to care was assessed through telephonic follow-up after a month of referral. RESULTS Of 780 participants, 85% had at least one comorbidity, risk determinant, or disability (multimorbidity). The prevalence of pulmonary disability was 60% (95% confidence interval: 56–64). Undernutrition (36%), diabetes (24%), and hypertension (19%) were the most common comorbidities, with 13% of diabetes and 55% of hypertension being newly detected. Pulmonary disability was associated with older age, pulmonary TB, undernutrition, mental health disorder, smoking, and silica exposure. Referral ranged from 12% to 100% for various conditions, with low rates for mental health disorders (12%) and recreational drug use (33%). CONCLUSION Successful completion of TB treatment and bacteriological cure does not imply restoration of health-related quality of life. Early integration of patient-centred care for multimorbidity is essential for restoring health among TB survivors.