Conclusion While substantial progress has been made in the field, the COVID-19 pandemic has caused major setbacks in TB control. The cycle of poverty and disease has worsened due to the joint epidemics of COVID-19 and TB. In addition, increasing poverty and hunger, comorbidities such as HIV, diabetes and the use of immunosuppressants, and behavioural risk factors such as smoking and alcohol consumption are expected to continue to contribute to TB epidemics globally. To change the tide and restore progress toward the elimination of TB, a multifaceted approach will be necessary. The global community must commit additional resources towards supporting a holistic approach that addresses the societal, personal and medical needs that would curb the TB epidemic. References 1 World Health Organization. Global Tuberculosis Report 2022. Geneva, World Health Organization, 2022. 2 World Health Organization. World Health Statistics 2022: Monitoring Health for the SDGS, Sustainable Development Goals. Geneva, World Health Organization, 2022. 3 Uplekar M, Weil D, Lonnroth K, et al. WHO’s new end TB strategy. Lancet 2015 385: 1799–1801. 4 World Health Organization. The End TB Strategy. Geneva, World Health Organization, 2015. 5 Glaziou P, Arinaminpathy N, Dodd PJ, et al. Methods used by WHO to estimate the global burden of TB disease. https://www.who.int/publications/m/item/methods-used-by-who-to-estimate-the-global-burden-of-tb- disease Date last accessed: 17 July 2023. 6 Institute for Health Metrics and Evaluation (IHME). GBD Results. https://vizhub.healthdata.org/gbd-results/ Date last accessed: 17 July 2023. 7 GBD 2019 Tuberculosis Collaborators. Global, regional, and national sex differences in the global burden of tuberculosis by HIV status, 1990–2019: results from the Global Burden of Disease Study 2019. Lancet Infect Dis 2021 22: 222–241. 8 World Health Organization. Global Tuberculosis Report 2022: TB Disease Burden: TB Incidence. https://www. who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022/tb-disease-burden/2- 1-tb-incidence Date last accessed: 28 June 2023. 9 Stop TB Partnership. Gender and TB. https://stoptb.org/assets/documents/global/awards/tbreach/TB-REACH_ Gender2021-web.pdf Date last accessed: 17 July 2023. 10 Horton KC, MacPherson P, Houben RMGJ, et al. Sex differences in tuberculosis burden and notifications in low- and middle-income countries: a systematic review and meta-analysis. PLoS Med 2016 13: e1002119. 11 Nguyen HV, Brals D, Tiemersma E, et al. Influence of sex and sex-based disparities on prevalent tuberculosis, Vietnam, 2017–2018. Emerg Infect Dis 2023 29: 967–976. 12 Mathad JS, Yadav S, Vaidyanathan A, et al. Tuberculosis infection in pregnant people: current practices and research priorities. Pathogens 2022 11: 1481. 13 Bates M, Ahmed Y, Kapata N, et al. Perspectives on tuberculosis in pregnancy. Int J Infect Dis 2015 32: 124–127. 14 Sobhy S, Babiker ZOE, Zamora J, et al. Maternal and perinatal mortality and morbidity associated with tuberculosis during pregnancy and the postpartum period: a systematic review and meta-analysis. BJOG 2017 124: 727–733. 15 Hui SYA, Lao TT. Tuberculosis in pregnancy. Best Pract Res Clin Obstet Gynaecol 2022 85: 34–44. 16 World Health Organization. Global Tuberculosis Report 2016. Geneva, World Health Organization, 2016. 17 World Health Organization. Global Tuberculosis Control: WHO Report 2011. Geneva, World Health Organization, 2011. 18 World Health Organization. WHO consolidated guidelines on tuberculosis. Module 5: management of tuberculosis in children and adolescents. Geneva, World Health Organization, 2022. 19 Stop TB Partnership. Words Matter: Suggested Language and Usage for Tuberculosis Communications. Geneva, Stop TB Partnership, 2022. 20 Drain PK, Bajema KL, Dowdy D, et al. Incipient and Subclinical Tuberculosis: a Clinical Review of Early Stages and Progression of Infection. Clin Microbiol Rev 2018 31: e00021-18. 21 Migliori GB, Ong CWM, Petrone L, et al. The definition of tuberculosis infection based on the spectrum of tuberculosis disease. Breathe 2021 17: 210079. 22 Kendall EA, Shrestha S, Dowdy DW. The epidemiological importance of subclinical tuberculosis a critical reappraisal. Am J Respir Crit Care Med 2021 203: 168–174. 23 Frascella B, Richards AS, Sossen B, et al. Subclinical tuberculosis disease–a review and analysis of prevalence surveys to inform definitions, burden, associations, and screening methodology. Clin Infect Dis 2021 73: e830–e841. https://doi.org/10.1183/2312508X.10023922 29 EPIDEMIOLOGY |R. VERSTRAETEN ET AL.