Undiagnosed burden of latent tuberculosis, active tuberculosis and tuberculosis-HIV co-infections in Africa-status quo, needs, priorities, and opportunities.

Tuberculosis (TB) remains a leading cause of morbidity and mortality in Africa, with latent TB infection (LTBI) and TB co-infections posing significant public health challenges. This viewpoint examines the undiagnosed burden of LTBI and TB co-infections across the continent, emphasizing findings from autopsy studies. Data from the World Health Organization's Global Tuberculosis Report 2024 and recent autopsy research highlight the prevalence of undetected TB cases, particularly among individuals with HIV. Autopsy studies reveal a substantial proportion of TB cases that were undiagnosed ante mortem, underscoring the limitations of current diagnostic approaches. The co-infection of TB with HIV exacerbates disease progression and complicates diagnosis and treatment. Addressing the hidden burden of LTBI and TB co-infections necessitates enhanced diagnostic strategies, increased autopsy surveillance, and integrated healthcare services to reduce transmission and improve patient outcomes in Africa.