Our analysis highlights underappreciated patterns in #TB exposure and transmission that are directly relevant to efforts to end TB. More systematic analyses to understand the epidemiology of TB transmission should be used to inform context-specific prevention and care strategies.

Across age groups, TB exposure typically peaked in adolescence. However, transmission contributions by age varied across regions with the highest proportion from adolescents aged 15-24 in AMR and SEAR, adults aged 35-44 in AFR and EUR, and older adults 65+ in EMR and WPR.

[NOT YET PEER REVIEWED]

Both exposure and transmission were higher in males than in females. We found that a majority of TB transmission was attributable to contact with adult men: 67% (95% UI 62-71%) of transmission to men, 52% (95% UI 49-56%) to women, and 63% (95% UI 58-68%) to children.

[NOT YET PEER REVIEWED]

6/ @petermacp.bsky.social and I seem to be the only coauthors on Bluesky, but this work comes from a great team across @hsph.harvard.edu @uofglasgow.bsky.social @tb-lshtm.bsky.social @lshtm-tbmod.bsky.social

5/ These findings show that, despite calls for gender responsive TB prevention and care, disparities have increased over the past three decades. Effective strategies to reduce men’s risk of TB and to engage men in TB prevention and care remain essential to end TB.

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4/ The stability of pooled estimates doesn't mean sex ratios have remained consistent. We found evidence that male-to-female ratios likely increased 1.6% (95% CrI -1.0-6.2%) annually over the period 1994–2021, with the greatest increase in the Western Pacific region.

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3/ We fitted multi-level Bayesian regression models to estimate a pooled male-to-female prevalence ratio of 2.21 (95% CrI 1.94-2.50) for bacteriologically-confirmed TB.

That's the same point estimate as our previous review, but the two studies used different analytical methods.

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2/ We updated our systematic review and identified 99 TB prevalence surveys reporting sex-disaggregated results (with >4 million participants) conducted between 1993 and 2024 in 33 low- or middle-income countries.

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... @arkaprabhagun.bsky.social Tom Sumner @cfmcquaid.bsky.social @raclark18.bsky.social @top-j.bsky.social Roel Bakker @yiranliu.bsky.social Mmamapudi Kubjane, Christian Lienhardt @richardwhite321.bsky.social @reinhouben.bsky.social

@lshtm-tbmod.bsky.social @tb-lshtm.bsky.social 9/9

This work provides an important update to previous comparisons of #TB interventions across the prevention and care cascade and was made possible by a massive team effort from @aschwalbc.bsky.social Martin Harker @laragosce.bsky.social Elena Venero-Garcia, Lily O'Brien ... 8/9