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Biopsychosocial determinants shape TB care outcomes across 124 studiesSocial and psychological factors impact tuberculosis treatment and outcomes
Frontiers in MedicinePublished September 24, 2026DOI ↗Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease
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Key Takeaway
Recognize biopsychosocial factors as correlates of poor TB outcomes, not proven causes.
This scoping review and bibliometric analysis examined the biopsychosocial determinants associated with tuberculosis care and treatment outcomes. The authors included 124 studies and identified 78 determinants spanning biological (n=25), psychological (n=25), and social (n=28) domains.
Across the reviewed empirical literature, HIV co-infection, diabetes, malnutrition, smoking, alcohol use, stigma, limited TB knowledge, poverty, and barriers to healthcare access were consistently associated with delayed diagnosis, poor treatment adherence, multidrug-resistant TB (MDR-TB), unsuccessful treatment outcomes, and mortality.
The authors did not undertake a meta-analysis because of substantial clinical and methodological heterogeneity. Effect sizes, p-values, confidence intervals, follow-up duration, and safety outcomes were not reported. The review is descriptive and bibliometric in nature, and the associations described should be interpreted as correlational rather than causal.
The findings support multidisciplinary TB control strategies that address biological, psychological, and social determinants to strengthen person-centered care. Clinicians should recognize that these determinants cluster and may jointly influence TB trajectories, though the review does not quantify their independent contributions or establish causality.
How this fits prior evidence
This scoping review extends prior coverage of TB determinants by mapping 78 biopsychosocial factors across 124 studies, consistent with earlier findings that TB prevalence reaches 16% in malnourished Ethiopian children and that fluoroquinolone resistance is acquired more frequently during TB treatment. It also aligns with prior work on optimized weight-based ethambutol dosing in children, reinforcing that biological and social factors jointly shape TB outcomes. Unlike those focused reports, this review is broad and associative, and heterogeneity precluded meta-analysis, so it complements rather than confirms specific causal pathways.
Treating tuberculosis is about more than just giving patients the right medicine. A review of 124 different studies found that a person's life outside the clinic plays a huge role in their recovery. Researchers identified 78 different factors that affect how well a patient manages the disease, spanning biological, psychological, and social areas.
Several specific issues were found to consistently make treatment harder. These include having other conditions like HIV or diabetes, as well as social hurdles like poverty and stigma. Factors like smoking, alcohol use, and a lack of knowledge about the disease also make it harder for patients to stick to their treatment plans. These challenges often lead to delayed diagnoses and worse health outcomes.
Because these issues are so varied, experts suggest that doctors and health systems should use a team approach. By addressing the social and psychological needs of the patient alongside medical treatment, care can become more centered on the person. While this review did not combine individual patient data into a single calculation, it highlights the wide range of factors that impact daily life for those fighting tuberculosis.
What this means for you:
Social factors like stigma, poverty, and lack of knowledge significantly impact tuberculosis treatment success.
Common questions
What social factors make tuberculosis harder to treat?
Several social factors make it harder for patients to get well. These include poverty, social stigma, and limited knowledge about tuberculosis. These issues can lead to delayed diagnoses and make it harder for patients to stick to their treatment plans.
How do other health conditions affect tuberculosis outcomes?
Having other health conditions like HIV infection or diabetes can make tuberculosis harder to manage. These co-infections, along with issues like malnutrition, are consistently linked to poorer treatment outcomes and higher risks of mortality.
What lifestyle factors impact recovery from tuberculosis?
Lifestyle factors such as smoking and alcohol use are linked to poorer outcomes. These factors, along with barriers to healthcare access, can lead to unsuccessful treatment and the development of multidrug-resistant tuberculosis.
BackgroundTuberculosis (TB) remains the leading infectious-disease cause of death globally, with an estimated 10.7 million incident cases and 1.23 million deaths in 2024. Its persistence is driven not by microbial factors alone, but by a complex interplay of biological, psychological, and social determinants influencing exposure, vulnerability, and access to care. Despite growing recognition of these biopsychosocial dimensions, the available evidence remains fragmented across disciplines, and no previous review has comprehensively mapped their scope while simultaneously characterizing the structure and evolution of this research field.MethodsWe conducted an integrated scoping review and bibliometric analysis. Scopus, PubMed, and Web of Science were searched from database inception through 21 January 2026. Empirical studies examining biological, psychological, or social determinants associated with TB care or treatment outcomes were eligible. Data were extracted using a structured charting framework following Joanna Briggs Institute (JBI) methodology and reported according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Bibliometric analyses were performed using VOSviewer and the Bibliometrix R package to characterize publication trends, collaboration networks, and thematic evolution. Study-specific effect estimates were summarized descriptively where available; meta-analysis was not undertaken because of substantial clinical and methodological heterogeneity.ResultsA total of 124 studies were included, identifying 78 determinants across biological (n = 25), psychological (n = 25), and social (n = 28) domains. HIV co-infection, diabetes, malnutrition, smoking, alcohol use, stigma, limited TB knowledge, poverty, and barriers to healthcare access were consistently associated with delayed diagnosis, poor treatment adherence, multidrug-resistant TB (MDR-TB), unsuccessful treatment outcomes, and mortality. Bibliometric analysis demonstrated sustained growth in research output and an expansion from predominantly biomedical topics toward mental health, social determinants, digital health, and data-driven approaches. Integration of findings identified evidence gaps, with several determinants strongly associated with adverse outcomes receiving comparatively limited research attention.ConclusionIntegrating a scoping review with bibliometric analysis provides a comprehensive understanding of biopsychosocial determinants associated with TB care and treatment outcomes while identifying evidence gaps and emerging research priorities. These findings support multidisciplinary TB control strategies addressing biological, psychological, and social determinants to strengthen person-centered care.Systematic review registrationhttps://osf.io/8fpky/, identifier 8fpky.
