Beyond Cure: Post-Tuberculosis Lung Disease in Science, Policy, and Practice

Summary
Post-Tuberculosis Lung Disease (PTLD) is an emerging, long-neglected consequence of TB that affects a large proportion of TB survivors and contributes to chronic respiratory morbidity, premature mortality, and sustained health system burden. This Research Topic aims to move the field beyond global consensus statements toward country-led, data-driven, and implementation-focused work that can inform policy, guideline development, and clinical practice, especially in high-burden settings and low- and middle-income countries (LMICs). By bringing together original clinical, epidemiological, economic, and implementation research, this collection seeks to define the burden and spectrum of PTLD, refine diagnostics and management approaches, and generate actionable evidence for integrated care models within TB, HIV, and broader health systems.

Background and Rationale
Post-Tuberculosis Lung Disease (PTLD) is increasingly recognized as a major global health challenge, affecting an estimated 40–60% of TB survivors and contributing to chronic respiratory symptoms, reduced quality of life, and long-term disability. As global TB programmes improve treatment success and survival, the number of people living with PTLD is growing, with the greatest burden in TB-endemic LMICs. Despite this, PTLD remains underdiagnosed, underreported, and largely absent from routine TB programme metrics, national guidelines, and health system planning.

The International Post-Tuberculosis Symposium (iPTBs) has defined PTLD research priorities and catalyzed global consensus around standardized definitions, diagnostic approaches, and future directions. However, most published work has been at the level of global reviews and consensus statements. Key gaps that this Research Topic aims to address include:
Limited country-led guideline development processes that translate iPTBs recommendations into context-appropriate national policies and clinical guidance.

Scarcity of original clinical and epidemiological data from high-burden settings that document the real-world spectrum, prevalence, phenotypes, and outcomes of PTLD.
Insufficient operational and implementation research on how to integrate PTLD care into existing TB, HIV, and primary care platforms, particularly in resource-constrained LMICs.
Underdeveloped economic and health system analyses that quantify the long-term impact and cost of PTLD and make the case for sustainable investment in PTLD care and rehabilitation services.

This collection will therefore build on, but not duplicate, iPTBs consensus outputs. Instead, it will generate new empirical evidence, country-specific policy and implementation experiences, and innovative approaches (including digital health and AI) that can be used by programmes, clinicians, and policymakers to design, cost, and scale PTLD services.

Scope and Thematic Areas
To maintain a focused and coherent scope, the Research Topic will prioritize work that directly informs burden estimation, diagnostics, management and rehabilitation, and policy and health systems integration of PTLD. We welcome submissions including, but not limited to, the following themes:
-Defining the Burden and Spectrum of PTLD
-Epidemiology in high-burden and LMIC settings
-Phenotypes, trajectories, and long-term outcomes
-Pathophysiology and Mechanisms
-Immunopathology and structural lung injury
-Biomarkers, imaging correlates, and phenotype–endotype linkages
-Clinical Assessment and Diagnostics
-Standardized diagnostic algorithms (e.g., spirometry, oscillometry, HRCT, ultrasound)
-Novel metrics and patient-reported outcomes
-Validation of diagnostic tools and scoring systems in diverse settings
-Management and Rehabilitation
-Pulmonary rehabilitation models adapted for TB-endemic LMICs
-Pharmacological and non-pharmacological interventions
-Long-term follow-up and models of chronic care for PTLD
-Policy, Guidelines, and Implementation
-National or subnational guideline development processes and policy reforms
-Integration of PTLD care into TB, HIV, and primary care platforms
-Operational and implementation research, including barriers, facilitators, and scalable models of care
-Economic Evaluation and Health Systems Integration
-Cost-effectiveness analyses of PTLD screening, diagnostics, and rehabilitation
-Health system impact, resource needs, and service delivery models
-Investment cases for PTLD within universal health coverage and essential health benefits packages
-Future Directions and Innovation
-AI-driven imaging and diagnostics
-Digital health tools for screening, triage, follow-up, and self-management
-Remaining research gaps not yet addressed by iPTBs, including pediatric PTLD, vulnerable populations, and equity considerations

Expected Contribution
We expect this collection to:
-Translate iPTBs global consensus into national policy, guidelines, and real-world practice.
Showcase original clinical, epidemiological, and policy experiences, emphasizing country-led leadership and context-specific solutions.
-Provide a platform for implementation research, health systems insights, and economic evaluation, areas that remain underexplored in prior PTLD work.
-By focusing on these priorities, the Research Topic will offer novel, practice-oriented insights that complement existing consensus statements and support the design, funding, and delivery of comprehensive PTLD care in high-burden settings.