ADVANCES, CHALLENGES, AND EMERGING THERAPIES IN TUBERCULOSIS: A COMPREHENSIVE REVIEW OF GLOBAL TUBERCULOSIS CONTROL AND FUTURE DIRECTIONS

Tuberculosis is a leading global cause of infectious morbidity and mortality, disproportionately affecting low- and middle-income countries with high population density and comorbidities like HIV and diabetes. The COVID-19 pandemic disrupted TB control efforts, halting declines in incidence and driving up mortality rates. MDR-TB and XDR-TB pose growing challenges worldwide, requiring prolonged, expensive, and toxic treatment regimens. Rapid assays such as Xpert MTB/RIF and line probe assays enable early detection and resistance profiling, augmented by novel biomarkers and AI for enhanced precision. Standard treatment for drug-sensitive TB remains a six-month regimen, while novel shorter regimens-including all -oral therapies with recently licensed drugs like bedaquiline, delamanid, and pretomanidare redefining MDR/XDR-TB management. Innovations include host-directed therapies that modulate immunity,nanotechnology for targeted drug delivery, and bacteriophage therapyin which phages selectively lyse drug resistant strains, bypassing antibiotics while exhibiting low toxicity. Hurdles persist in standardization and access. Integrated diagnostics, phage like innovations, public health initiatives, equity, and commitment are essential to reverse the epidemic and meet elimination targets.