Tuberculosis in South Asia: A Regional Analysis of Burden, Progress, and Future Projections Using the Global Burden of Disease (1990-2021)

Background: Tuberculosis (TB) is a major public health issue in South Asia and accounts for a large share of the global TB burden. Despite global efforts to curb TB incidence and mortality, progress in South Asia has been uneven, necessitating focused regional analysis to guide effective interventions. This study aims to analyse the trends in the TB burden in South Asia from 1990 to 2021 and project future TB incidence rates up to 2031. Methods: This study utilized data from the Global Burden of Disease (GBD) 2021 results to analyse trends in age-standardized incidence (ASIR), prevalence (ASPR), mortality (ASMR), and disability-adjusted life years (DALYs) rates (ASDR) associated with TB in South Asia from 1990 to 2021. Joinpoint regression analysis was employed to identify significant trends, whereas ARIMA models were used to project future TB incidence rates up to 2031. Results: This study revealed significant declines in the ASIR, ASPR, ASDR, and ASMR related to TB in South Asia over the past three decades. Prominent reductions were found in Bangladesh and Bhutan, whereas India, Pakistan, and Nepal continue to bear the highest TB burdens. The ARIMA model projections indicate a continued decline in TB incidence across the region, although the extent of the decline varies by country, with less favourable trends observed in Nepal and Pakistan. The analysis also highlights tobacco use, high fasting plasma glucose, and high body mass index as significant risk factors contributing to the TB burden. Conclusions: Substantial progress has been made in reducing the TB burden in South Asia; however, sustained and intensified efforts are needed, particularly in countries with inconsistent progress. These findings emphasize the need for targeted interventions to meet the WHO End TB Strategy (WETS) targets by 2035. Continuous monitoring and adaptive strategies will be crucial in maintaining and accelerating progress toward TB elimination in South Asia.