Family first: integrating principles of family-centered care to improve the tuberculosis care cascade

Tuberculosis (TB) remains a leading cause of morbidity and mortality worldwide, with persistent losses across the care cascade from screening and diagnosis to treatment completion and prevention. While TB programs have largely focused on disease control and individual patients, many barriers to care arise at the household level, including stigma, financial strain, caregiving demands, and limited access to information and support. Family-centered care (FCC), which engages families as active partners through shared decision-making, respect, and tailored support, has improved outcomes in other health areas but has not been systematically applied to TB. Here, we argue that integrating FCC into TB care can reduce losses across the cascade and improve outcomes for individuals and households. FCC offers a unifying framework to strengthen engagement, equity, and continuity of care. It can address key barriers by promoting tailored education, shared treatment planning, household involvement, and coordinated social, economic, and clinical supports across prevention, diagnosis, treatment, and follow-up. Drawing on existing evidence and case vignettes, we outline practical strategies to align FCC principles with TB program activities. We also highlight key considerations for implementation, including workforce training, community partnerships, resource needs, and potential trade-offs such as caregiver burden or unintended stigma, underscoring the importance of context-specific adaptation. Adopting a family-centered approach provides a pragmatic pathway to strengthen TB programs, enhance patient and household experiences, and accelerate progress toward TB elimination.