Socioeconomic, Cultural, and Health System Determinants of Drug-Resistant Tuberculosis: A Comprehensive Insight from Kenya and India

The problem of drug-resistant tuberculosis (DR-TB) persists as a global public health problem, especially in low- and middle-income countries, where socioeconomic inequalities and health-system challenges delay timely diagnosis, treatment, and care, thereby increasing the likelihood of a relapse. The socioeconomic, cultural and health-system determinants of DR-TB in Kenya and India as well as multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB), paediatric tuberculosis, surveillance, and post-tuberculosis lung disease (PTLD) are reviewed. The review highlights the situation since 2015, and presents a comparison of the epidemiological context and national tuberculosis control strategies of the two countries. Poor health and social care systems are identified as significant factors contributing to the failure of tuberculosis prevention and control, including poverty, undernutrition, overcrowding, stigma, indirect healthcare costs and delays in seeking care. The co-epidemic of TB and HIV, coupled with inadequate access to health services and resources, create unique challenges in Kenya. India has a high absolute burden of tuberculosis and the lack of timely drug-susceptibility testing, and fragmented care pathways make controlling DR-TB difficult. While both countries have introduced molecular diagnostics, decentralised service and community support, and shortened all-oral treatment courses, there are issues with paediatric case detection, treatment continuity, social protection, and future respiratory care. This comparison outlines the importance of the contextual integration of biomedical interventions with equitable healthcare delivery, nutrition and socioeconomic support, enhanced surveillance, and systematic post-treatment assessment. Addressing these interconnected determinants is critical to reduce the spread of TB, increase the chances of success of treatment and minimize the long-term impact of DR-TB in both settings