Systemic Gaps and Roadmap for Integrated Care for Post-tuberculosis Lung Disease in Ethiopia: A Narrative Review

Post-tuberculosis lung disease (PTLD) is a major cause of chronic respiratory impairment globally, yet it remains a critically neglected complication in high-burden, low-resource settings. This narrative review synthesizes evidence on PTLD, with a specific focus on Ethiopia, to analyze the health system gaps and propose actionable solutions. We conducted a narrative review of published and grey literature on the clinical burden, socioeconomic impact, and health system challenges of PTLD, with a particular emphasis on Ethiopia. Evidence was selected for relevance to PTLD phenotypes, diagnosis, management, and health system integration. PTLD, encompassing conditions like bronchiectasis, chronic obstructive pulmonary disease (COPD), and pulmonary fibrosis, affects a substantial proportion of tuberculosis (TB) survivors, leading to chronic respiratory symptoms, lung function disability, and socioeconomic impact. In Ethiopia, despite its inclusion as a priority lung disease in the national strategic plan, critical gaps persist. These include a profound lack of clinical and patient awareness, severely limited diagnostic capacity (spirometry, imaging), absent treatment and rehabilitation pathways, a scarcity of local epidemiological and implementation research, and unaddressed policy system barriers that impact infectious and chronic disease care. Ethiopia's policy recognition of PTLD is a pivotal first step. An urgent, coordinated effort is required to translate this into functional, equitable care. Success depends on concurrent action by researchers to generate local evidence, public health institutes to integrate surveillance and develop guidelines, clinicians to pioneer service delivery models, and policymakers to mandate and fund integration. Bridging the PTLD care gap is essential to safeguard the long-term health of TB survivors and strengthen the health system's capacity to manage chronic disease.