Betel Quid Use and Tuberculosis Transmission: A Neglected Focus Area for Tuberculosis Control in Low- and Middle-Income Countries.

Habitual betel quid consumption and spitting contribute 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 patients with TB, there exists a knowledge gap in the relationship between quid use and TB, which presents as a neglected opportunity to address the global burden of TB in low- and middle-income countries. Understanding such a knowledge gap is crucial when taking measures at various levels, including research prioritization, behavior change communication, and legislation to address the availability and access of quid products, coupled with community-based interventional strategies. This article thus presents empirical evidence on quid use and its effects on TB spread and identifies feasible, applicable changes required at various levels to curtail the spread of TB among betel quid users.