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

Drug-resistant tuberculosis (DR-TB), including multidrug-resistant TB (MDR-TB), is a major challenge to global TB elimination, especially in low-and middle-income countries. This review explores the impact of socioeconomic , cultural and health-system factors on the emergence and spread of DR-TB in Kenya and India since 2015, with particular regard to the social determinants, programmatic difficulties and political factors, including MDR-TB, pediatric TB, surveillance and post-TB lung disease (PTLD). Evidence indicates that poverty, overcrowding, malnutrition, stigma, and delays in seeking care continue to drive transmission and drug resistance in both countries. In Kenya, high rates of HIV co-infection and inadequate health-care funding contribute to the burden. In India, the problems include high MDR-TB transmission, inadequate management in private health care, and delayed diagnosis. Since 2015, access to molecular diagnostics, decentralized services, integrated TB-HIV care and all-oral MDR-TB treatment for a shorter duration has improved in both countries. A holistic approach is needed to combat TB, considering biomedical and socio-structural factors, health system improvement, and equitable access to prevention, diagnosis, treatment and post-TB care.