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.