Diagnostics, surveillance and environmental drivers of TB in Borneo

Tuberculosis (TB) is the second leading cause of death from infectious disease after COVID-19. In 2021, 10.6M fell ill and 1.6M died from TB. Ending TB epidemics by 2030 is among the health targets (Target 3.3) of the United Nations Sustainable Development Goals (SDGs). In Malaysia, TB related mortality is reducing but not sufficiently to meet the global End TB Strategy milestones. Sabah Malaysia has particular problems with historically higher burdens of TB. Here, geographic hotspots of TB patients currently correspond with migration hubs and dense urbanised population centres, but with patchy surveillance, delayed health seeking and limited access to TB care this might not be a true reflection of disease distribution. Access to healthcare provision is particularly difficult within Sabah's interior, which is topographically challenging and renowned for its iconic wildlife. While bovine TB is primarily a disease of livestock, spread of bTB from cattle to wildlife is well documented in other countries, but in Malaysia TB/bTB surveillance in wildlife has been largely neglected. We do know though that TB infections are likely common in wildlife and for example have previously delayed the release of captive orangutans back to their natural habitats.