Advancing the Fight Against Tuberculosis: Integrating Innovation and Public Health in Diagnosis, Treatment, Vaccine Development, and Implementation Science

Ayman Elbehiry^1*Husam M Edrees²Riyad Alshaqi³Eman Marzouk^1*Adil Abalkhail¹Enas N Morgan⁴Abousree Ellethy⁵Feras Alzaben⁶Sulaiman Anagreyyah⁷Ahmad Algarni⁷Khalid Almuhaydili⁸Ibrahim Alotaibi⁹Abdulrahman Albaqami⁹Khalid Alamri¹⁰Mai Ibrahem¹¹Abdulaziz M. Almuzaini¹²Akram Abu-Okail¹³

• ¹Department of Public Health, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
• ²Department of Physiology, Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia
• ³Defence Against Weapons of mass Destruction Department, Armed Forces Medical Services, Riyadh City, Saudi Arabia
• ⁴Department of Physical Therapy, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
• ⁵Department of Basic Oral Sciences and Dental Education, College of Dentistry, Qassim University, Buraydah, Saudi Arabia
• ⁶Department of Food Service, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
• ⁷Family Medicine Department, King Fahad Armed Hospital, Jeddah, Saudi Arabia
• ⁸Health Informatics Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
• ⁹Education and training Department, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
• ¹⁰Pharmaceutical Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
• ¹¹Department of Public Health, College of Applied Medical Science, King Khalid University, Abha, Saudi Arabia
• ¹²Department of Veterinary Preventive Medicine, College of Veterinary Medicine, Qassim University, Buraydah, Saudi Arabia
• ¹³Department of Pathology and Laboratory Diagnosis, College of Veterinary Medicine, Qassim University, Buraydah, Saudi Arabia

Tuberculosis (TB) remains one of the leading causes of infectious disease mortality worldwide, increasingly complicated by the emergence of drug-resistant strains and limitations in existing diagnostic and therapeutic strategies. Despite decades of global efforts, the disease continues to impose a significant burden, particularly in low-and middle-income countries (LMICs) where health system weaknesses hinder progress. This comprehensive review explores recent advancements in TB diagnostics, antimicrobial resistance (AMR surveillance), treatment strategies, and vaccine development. It critically evaluates cutting-edge technologies including CRISPR-based diagnostics, whole-genome sequencing, and digital adherence tools, alongside therapeutic innovations such as shorter multidrug-resistant TB regimens and host-directed therapies. Special emphasis is placed on the translational gap-highlighting barriers to realworld implementation such as cost, infrastructure, and policy fragmentation. While innovations like the Xpert MTB/RIF Ultra, BPaLM regimen, and next-generation vaccines such as M72/AS01E represent pivotal progress, their deployment remains uneven. Implementation science, cost-effectiveness analyses, and health equity considerations are vital to scaling up these tools. Moreover, the expansion of the TB vaccine pipeline and integration of AI in diagnostics signal a transformative period in TB control. Eliminating TB demands more than biomedical breakthroughs-it requires a unified strategy that aligns innovation with access, equity, and sustainability. By bridging science with implementation, and integrating diagnostics, treatment, and prevention within robust health systems, the global community can accelerate the path toward ending TB.