Australia Detects Most TB Cases Through Visa Checks, but Experts Warn New Drug Won't Change Treatment Yet
When Parth, a 23-year-old migrant living in Brisbane, booked a routine visa medical, he expected paperwork. Instead, a "suspicious shadow" on his lung led to a three-month diagnostic ordeal and a tuberculosis diagnosis he never saw coming — one of the roughly 89% of Australian TB cases detected in overseas-born residents.
He mentions that each test took weeks. By the time they confirmed it, nearly three months had passed.
Australia's visa screening system often detects TB earlier than symptoms appear, particularly among people born overseas. A large study published by The Lancet Regional Health – Western Pacific found that up to 89 per cent of Australian TB cases occur in overseas-born residents, with one active case detected for every 1,887 visa applicants screened.
While TB remains uncommon in Australia, visa screening plays an outsized role in identifying it. Early detection, however, does not mean an easier journey. Once diagnosed, every patient, symptomatic or not, must follow the same rigid, six-month course of antibiotics introduced decades ago. And despite recent global excitement around a new TB drug, experts warn it will not shorten treatment for most patients in the near future.
After his initial X-ray, Parth was told to return for follow-up imaging and sputum tests — the samples that would eventually confirm his TB diagnosis. "I wasn't coughing, I wasn't sick. Nothing felt wrong," he said. "They said something looked off and they needed to investigate."
One blood test was negative, but a sputum culture, which can take six to eight weeks to grow, came back positive. The diagnosis disrupted almost every part of his life. He took more than two weeks off work to begin treatment, and once the medication started, he developed a range of side effects from widespread itching to orange-coloured urine and occasional difficulty breathing. His daily medication schedule is strict and closely monitored.
The burden falls disproportionately on migrants
Although TB affects people from all backgrounds, data show a disproportionate impact on overseas-born residents, especially outside major cities. A 2023 retrospective analysis of Victorian TB cases found that two-thirds of regional TB notifications occurred in people born overseas.
Region also shapes how quickly patients receive treatment. The same study found longer delays in diagnosing extrapulmonary TB in regional areas than in metropolitan areas.
Inside Australia's TB treatment system
According to infectious diseases physician Dr Gail Cross, a TB diagnosis immediately triggers the same strict six-month regimen of isoniazid, rifampicin, ethambutol and pyrazinamide. This protocol has guided treatment for decades and still applies even to patients with few or no symptoms.
Parth began his treatment under close clinical monitoring. "I needed to call the clinic every morning so they could confirm I'd taken my medication," he said.
Dr Cross confirmed that this method is intentional. "In Victoria, we don't use DOT in the traditional sense," she said. "Our TB caseload is low enough that we can support patients individually without requiring them to be physically observed swallowing tablets. Other states with higher burden use video-observed therapy instead."
She added that the weeks of waiting before diagnosis and the long months of treatment afterwards can be overwhelming, particularly for patients navigating the system alone or far from family.
A promising new drug — but not for patients like Parth
Much of the recent excitement at the Union Conference on Lung Health centred around sorfequiline, a new antibiotic showing early promise in combination therapy for drug-resistant TB. But Cross warns against over-interpreting the headlines — the drug is not intended for drug-sensitive TB, which is what the majority of people are diagnosed with. She described the trial results as "early days."
"Sorfequiline will be reserved initially for drug-resistant TB. We need to protect new antibiotics from overuse, or resistance will develop quickly," she said. Its main advantage appears to be an improved safety profile: "The early data suggest it may carry a lower risk of heart rhythm changes compared to bedaquiline. That's significant — but again, early."
For now, shortening treatment for ordinary, drug-sensitive TB remains unlikely. The six-month standard is not expected to change anytime soon.
Living with TB far from home
For Parth, the hardest part wasn't the diagnosis; it was managing everything alone. His parents, still in India, were "pretty worried," he said. "Their child is literally on another continent, and they can't do anything about it." At one point, he even researched flights home and worked out whether getting treated in India would be quicker and cheaper.
Cross says this is precisely why streamlining diagnosis and support systems remains crucial — visa screening helps prevent TB transmission, but the process can place significant emotional and practical pressure on patients, especially migrants.
What lies ahead
For now, the treatment Parth is undergoing remains the global standard. Even if sorfequiline is approved, with Johnson & Johnson producing the drug, Cross expects its early price to be high, further slowing access. For Parth, recovery is still a careful sequence of tablets and appointments. Research may reshape TB treatment in the future, but the present remains unchanged for patients like him.