Prehabilitation in adult cancer patients: an overview of systematic reviews.

Tuberculosis (TB) remains a significant global public health challenge, with the 2025 World Health Organization (WHO) Global TB Report documenting approximately 10.7 million incident cases and 1.23 million deaths in 2024 []. Despite standardized treatment regimens achieving cure rates of approximately 90%, suboptimal prescribing, poor adherence, and drug quality issues have driven the emergence of drug-resistant tuberculosis (DR-TB), including isoniazid-resistant tuberculosis, rifampicin-resistant (RR-TB), multidrug-resistant (MDR-TB), pre-extensively drug-resistant (pre-XDR-TB), and extensively drug-resistant (XDR-TB) strains []. Among an estimated 390,000 DR-TB patients globally in 2024, only approximately 40% received standardized treatment, with an overall treatment success rate below 75% []. This low treatment coverage leaves a substantial number of DR-TB patients undiagnosed or untreated, posing persistent risks of mortality and transmission []. High-burden countries, such as China, India, the Philippines, and Russia, account for more than half of the global multidrug-resistant and rifampicin-resistant tuberculosis (MDR/RR-TB) caseload, highlighting the concentrated geographic impact of this epidemic []. Household contacts (HHCs), defined as persons who shared the same enclosed living space with an index patient for one or more nights, or for frequent or extended daytime periods, during the three months before the start of the index patient’s current treatment [], represent a high-risk population within the DR-TB transmission chain and remain insufficiently addressed in many high-burden settings. Compared with drug-susceptible tuberculosis (DS-TB), DR-TB is characterized by longer treatment durations, slower sputum culture conversion, and greater bacteriological positivity, collectively amplifying household transmission risk []. Molecular epidemiological studies have confirmed high strain concordance between index DR-TB cases and HHCs who subsequently developed disease, with resistance profiles frequently shared between index cases and contacts who developed active TB []. These findings support household transmission as a primary route of DR-TB dissemination. Epidemiological data indicate that approximately 37–39% of HHCs are diagnosed with latent tuberculosis infection (LTBI) []. Although LTBI is not infectious, it can reactivate during immune compromise to cause active disease and sustain transmission [, ]. Systematic screening and management of HHCs are therefore fundamental to interrupting secondary DR-TB transmission. While international guidelines have converged on this priority, they diverge substantially in recommended strategies, owing to heterogeneity in resource availability and epidemiological context. The 2024 WHO consolidated guidelines on tuberculosis preventive treatment (TPT) advocate systematic multi-modal screening (symptom assessment, immunological tests, imaging, and molecular assays) combined with a 6-month levofloxacin-based preventive treatment regimen []. The European Centre for Disease Prevention and Control (ECDC) surveillance data highlight substantial regional variation in the epidemiology and burden of DR-TB across European countries, underscoring the need for context-specific prevention and control strategies []. The 2025 joint guidelines from the American Thoracic Society (ATS), Centers for Disease Control and Prevention (CDC), European Respiratory Society (ERS), and Infectious Diseases Society of America (IDSA) explicitly classify DR-TB exposure as a systematic screening indication in children []. However, significant implementation gaps remain across settings with varying resource availability. High-income settings typically deploy interferon-gamma release assays (IGRAs) and molecular testing within structured contact management systems, whereas resource-constrained low- and middle-income countries (LMICs) rely predominantly on symptom screening and tuberculin skin tests (TSTs), resulting in suboptimal contact tracing completeness and TPT initiation rates [–].