Betel Quid Use and Tuberculosis Transmission: A neglected focus area for Tuberculosis Control in LMIC’s

Abstract Habitual betel quid consumption and spitting contributes to Tuberculosis (TB) transmission due to direct exposure to pathogens, immunosuppression, and social contact. Despite betel quid being classified as a Group 1 Human Carcinogen, and a high prevalence of betel quid consumption in TB patients, there exists a knowledge gap in the relationship between quid use and TB, which presents as neglected opportunity to address the global burden of Tuberculosis in Low- and Middle-Income Countries (LMIC’s). Understanding such a knowledge gap is crucial when taking the measures at various levels including research prioritization, behavior change communication, legislation to address the availability and access of quid products coupled with community-based interventional strategies. This paper thus looks at empirical evidence on quid use and its effects on Tuberculosis spread and identifies feasible, applicable changes required at various levels to curtail the spread of Tuberculosis among betel quid users.