Global, regional, and national burden of tuberculosis and multidrug-resistant tuberculosis by HIV status, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023

Usha Adiga Emad M. Abdallah Meriem Abdoun Eman Abu-Gharbieh Amr Selim Abu Lila Siddig Ibrahim Abdelwahab Rashad Abdul-Ghani Anirudh Balakrishna Acharya Mohd Adnan Victor Adekanmbi Dhiraj Motilal Agarwal Asrat Agalu Abejew Samar Abd Elhafeez Jeza Muhamad Abdul Aziz Ripon Kumar Adhikary Muhammad Sohail Afzal Auwal Abdullahi Ukachukwu O. Abaraogu Rana Kamal Abu Farha Isaac Yeboah Addo Bilyaminu Abubakar Ahmad Y. Abuhelwa Olatunji O. Adetokunboh Ali Abuhaliema Obed Adonteng-Kissi Lawan Hassan Adamu Sherief Abd-Elsalam Swetha Acharya Williams Agyemang-Duah Mei Fong Liew Charles Oluwaseun Adetunji Juliana Bunmi Adetunji Aseel Aburub Deldar Morad Abdulah Abiola Victor Adepoju Jiawei He Makinde Adebayo Adeniyi Abdu A. Adamu Rezheen Fatah Abdulrahman Olumide Thomas Adeleke Feleke Doyore Agide Jorge R. Ledesma Babatope Oluwadamilare Adebiyi Olifan Zewdie Abil Sawsan Abuhammad Kamoru Ademola Adedokun Percival Delali Delali Agordoh Oluwawemimo Oluseun Adebowale Arailym Abilbayeva Ebenezer Afrifa-Yamoah Yasir M. Abdulateef Abdul Momin Rizwan Ahmad Mai Abdel Haleem Abusalah Aanuoluwapo Adeyimika Afolabi Samuel M. Ostroff Richard Gyan Aboagye Molalign Aligaz Aligaz Adisu Shimaa M. Aboelnaga Huong Thi Chu Navidha Aggarwal Wondimnew Desalegn Addis Ridwan Olamilekan Adesola Ali Abdolizadeh Arman Abdous Nagah M. Abourashed Prince Owusu Adoma Gizachew Beykaso Agafari Belete Muluadam Admassie Regina Mae Villanueva Dominguez Hana J. Abukhadijah Abdullahi Tunde Aborode Meixin Zhang Jianing Ma Abdulrakib Abdulrahim Hassan Abolhassani Saheed Ayodeji Adekola Sophie Mei Lin Whikehart Oluwatobi E. Adegbile Habtamu Abebe Getahun Nuhu Lawan Adamu None Abdullah Sadik Abdulwehab Belayneh Jejaw Abate Megan Verma Syed Hani Abidi Tajudeen Adesanmi Adebisi Wakgari Mosisa Abdisa Amanda Movo Mahdi Aghaalikhani Yasir M. Abdulateef Krishna Prasad Acharya Adamu Adamu Ahmad Hassan A. Abdou Zirak Ahmed Abdulrahman Nagah M. Abourashed Hatem A Eltaly Mazhar Abbas Vijay K. Aggarwal Adnan Ahmad Nermeen Abu-Elala Olumide Abiodun Saira Afzal

Publication Name: Lancet Infectious Diseases

Publication Date: 2026-01-01

Volume: Unknown

Issue: Unknown

Page Range: Unknown

Description:

Background: Tuberculosis (TB) is the leading global cause of death from a single infectious agent. Recent reductions in global health funding have threatened TB control, making comprehensive assessment of TB, HIV-related TB, and drug-resistant TB burdens before these disruptions essential for shaping effective responses. The WHO End TB Strategy sets targets of a 95% reduction in TB deaths and a 90% reduction in TB incidence between 2015 and 2035. Using results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, this study aims to assess the burden of TB and multidrug-resistant TB (MDR-TB) across 204 countries and territories, and to evaluate progress towards the WHO End TB incidence and mortality targets. Methods: We quantified TB mortality using the Cause of Death Ensemble modelling platform with global vital registration, surveillance, verbal autopsy, and minimally invasive tissue sampling data. For TB morbidity estimation, we simultaneously modelled incidence, prevalence, and mortality by age and sex using DisMod-MR 2.1. A population attributable fraction (PAF) approach was applied to stratify morbidity and mortality estimates by HIV and drug-resistance status. We also calculated disability-adjusted life-years (DALYs) as the sum of years of life lost and years lived with disability. For the risk factor analysis, a comparative risk assessment framework was used and PAFs were derived for alcohol use, smoking, and high fasting plasma glucose to determine the proportion of TB burden associated with these risk factors. Findings: In 2023, there were an estimated 9·11 million (95% uncertainty interval 8·04–10·3) incident cases of all-form TB, 1·22 million (0·98–1·49) deaths, and 54·6 million (43·8–65·5) DALYs globally. HIV-related TB comprised 781 000 (690 000–879 000) incident cases and 210 000 (142 000–279 000) deaths, contributing 11·0 million (7·56–14·3) DALYs. MDR-TB accounted for 466 000 (198 000–1 080 000) incident cases, 102 000 (31 700–238 000) deaths, and 3·96 million (1·31–9·01) DALYs. From 2015 to 2023, global all-form TB incidence rates declined by 19·2% (17·8–20·5) and deaths declined by 22·6% (4·7–35·7); declines were larger for drug-susceptible TB than for MDR-TB. Sub-Saharan Africa and south Asia had the highest mortality burdens in 2023; reductions in all-form TB incidence and mortality were uneven between 2000 and 2023, with limited progress in both measures in Latin America and the Caribbean. Removing smoking, alcohol use, and high fasting plasma glucose would reduce global TB deaths to 768 000 (592 000–970 000) and DALYs to 34·9 million (27·8–43·8) in 2023; MDR-TB deaths would decrease to 77 200 (23 400–183 000) and DALYs to 3·12 million (1·03–7·29). Interpretation: Global progress towards WHO End TB targets is disparate and fragile. Although many regions achieved meaningful gains, others have stagnated in recent years. The complexity of TB prevention is amplified by divergent MDR-TB trends, the persistent burden of HIV, and growing exposure to modifiable risk factors. Recent volatility in global health financing threatens to further destabilise this vulnerable epidemiological landscape; concerted action is urgently needed to temper disruptions and preserve progress. Funding: Gates Foundation.

Open Access: Yes

DOI: 10.1016/S1473-3099(26)00295-1

Authors - 102

Usha Adiga

14057674100

Emad M. Abdallah

16644652400

Meriem Abdoun

20336514800

Eman Abu-Gharbieh

24586714800

Amr Selim Abu Lila

25723054600

Siddig Ibrahim Abdelwahab

26029049500

Rashad Abdul-Ghani

26032503400

Anirudh Balakrishna Acharya

35751874500

Mohd Adnan

36022136700

Victor Adekanmbi

53463192900

Dhiraj Motilal Agarwal

54398213500

Asrat Agalu Abejew

55204820500

Samar Abd Elhafeez

55551273300

Jeza Muhamad Abdul Aziz

55670686800

Ripon Kumar Adhikary

55847469100

Muhammad Sohail Afzal

56009310800

Auwal Abdullahi

56102934500

Ukachukwu O. Abaraogu

56119041500

Rana Kamal Abu Farha

56283149600

Isaac Yeboah Addo

56305995900

Bilyaminu Abubakar

56389502700

Ahmad Y. Abuhelwa

56588047800

Olatunji O. Adetokunboh

56598104300

Ali Abuhaliema

56721413400

Obed Adonteng-Kissi

56841541000

Lawan Hassan Adamu

56926568700

Sherief Abd-Elsalam

57189845325

Swetha Acharya

57190209243

Williams Agyemang-Duah

57190228903

Mei Fong Liew

57190981691

Charles Oluwaseun Adetunji

57192176047

Juliana Bunmi Adetunji

57192177427

Aseel Aburub

57192834139

Deldar Morad Abdulah

57200190808

Abiola Victor Adepoju

57201300225

Jiawei He

57201492225

Makinde Adebayo Adeniyi

57201493506

Abdu A. Adamu

57202024381

Rezheen Fatah Abdulrahman

57202378819

Olumide Thomas Adeleke

57204237787

Feleke Doyore Agide

57204329765

Jorge R. Ledesma

57204449040

Babatope Oluwadamilare Adebiyi

57204551152

Olifan Zewdie Abil

57204558002

Sawsan Abuhammad

57205384547

Kamoru Ademola Adedokun

57207983240

Percival Delali Delali Agordoh

57208491603

Oluwawemimo Oluseun Adebowale

57211681492

Arailym Abilbayeva

57212445422

Ebenezer Afrifa-Yamoah

57213592889

Yasir M. Abdulateef

57213594352

Abdul Momin Rizwan Ahmad

57215340886

Mai Abdel Haleem Abusalah

57215901714

Aanuoluwapo Adeyimika Afolabi

57219351723

Samuel M. Ostroff

57219860984

Richard Gyan Aboagye

57221438826

Molalign Aligaz Aligaz Adisu

57222321507

Shimaa M. Aboelnaga

57223324838

Huong Thi Chu

57224162469

Navidha Aggarwal

57224993442

Wondimnew Desalegn Addis

57225020210

Ridwan Olamilekan Adesola

57255844500

Ali Abdolizadeh

57258035200

Arman Abdous

57263159900

Nagah M. Abourashed

57450956800

Prince Owusu Adoma

57777244400

Gizachew Beykaso Agafari

57790095900

Belete Muluadam Admassie

57845081200

Regina Mae Villanueva Dominguez

57861613300

Hana J. Abukhadijah

57865346000

Abdullahi Tunde Aborode

57916532700

Meixin Zhang

58031231300

Jianing Ma

58040920000

Abdulrakib Abdulrahim

58090198900

Hassan Abolhassani

58597704600

Saheed Ayodeji Adekola

58761789400

Sophie Mei Lin Whikehart

58950319700

Oluwatobi E. Adegbile

58998875200

Habtamu Abebe Getahun

59135717500

Nuhu Lawan Adamu

59229549900

None Abdullah

59244237300

Sadik Abdulwehab

59335627100

Belayneh Jejaw Abate

59371996200

Megan Verma

59452519100

Syed Hani Abidi

59663694600

Tajudeen Adesanmi Adebisi

59997997500

Wakgari Mosisa Abdisa

59998578600

Amanda Movo

60175065400

Mahdi Aghaalikhani

60211450000

Yasir M. Abdulateef

60229909700

Krishna Prasad Acharya

60410586000

Adamu Adamu Ahmad

60410587700

Hassan A. Abdou

60600943100

Zirak Ahmed Abdulrahman

60706234500

Nagah M. Abourashed

60720205400

Hatem A Eltaly

60725401900

Mazhar Abbas

60725402000

Vijay K. Aggarwal

60725451000

Adnan Ahmad

60725500900

Nermeen Abu-Elala

60725552900

Olumide Abiodun

7003859089

Saira Afzal

7004381116