WHO on World TB Day 2017: “Need to invest more in R&D”

World Tuberculosis Day, falling on March 24 each year, brings attention to a disease that affects one third of the world but is poorly understood by many people. To get an expert insight into the current state of the fight against TB, we spoke to Dr Mario Raviglione, Director of the Global TB Programme at the World Health Organization (WHO).


9 Liverpool TBAlliance Clinical Trial Session 27-10-2016 (6)For most people in Europe, tuberculosis is a disease of the past. How can we change this perception, and make people realise that TB is a serious global health problem today?

Dr Raviglione: We need to raise people’s awareness of the dangers the disease poses. This is challenging, because active TB is closely linked to poverty and mostly affects people living in low- and middle-income countries. However, it is also a big issue for vulnerable and marginalised populations in other parts of the world, such as migrants, refugees, elderly people, alcoholics and drug users. To take this consideration into account, the 2030 Agenda for Sustainable Development aims at “leaving no one behind” in the fight against TB.

In my opinion, when it comes to knowledge and information, North America is better prepared for TB than Europe. Whenever I travel around Europe and talk to people about my work, they are surprised and tell me “Oh, but I thought tuberculosis was extinct”. However, TB is the world’s number one killer when it comes to infectious diseases. It is responsible for almost double the number of deaths due to Aids and four times the number of deaths due to malaria.

Why is it that TB remains such a difficult disease to eradicate?

Dr Raviglione: Approximately one third of the world’s population is latently infected with TB, but don’t know they are infected as there are no symptoms for simple infection before the onset of the active disease. That’s what we call a “latent infection”. TB infection becomes active disease in around ten per cent of people in a lifetime. Usually, the disease breaks out when a second factor that weakens the immune system is added. This could be malnutrition, other diseases like AIDS or diabetes, smoking or alcohol abuse, for instance.

Another big issue we face today is that more and more forms of multidrug-resistant TB (MDR-TB) are emerging. These are forms of the TB bacteria that are resistant to one or more of the drugs that are currently available, and up to five per cent of the people infected with TB worldwide suffer from MDR-TB. This is why action against MDR-TB and research for new drugs must be an integral part of the antimicrobial resistance (AMR) agenda.

AHOY_DSW_imagine2030_infographic02_TBWhat do we need to do if we are to end the epidemic of TB worldwide by 2030, as the world’s political leaders committed to in the SDGs?

Dr Raviglione: We need to raise awareness for the disease and call for action. First of all, we need better diagnostics, to get reliable results quickly – including for latent TB. The big problem today is that cases of TB still go undiagnosed and untreated. TB is a slow disease, so people themselves and doctors only detect the disease when it has turned active and the patient already has infected other people – when it is too late, due to airborne transmission. Therefore, people everywhere need access to quality health care. Of course, we also need to provide people with effective treatment – and one that comes with few or no side effects.

Right now, we are also struggling to ensure that TB is part of the AMR agenda at the G20 summit in July in Hamburg. AMR poses a huge threat in the fight against TB. We should not allow the situation to get out of control.

Finally, we need to protect people from getting infected in the first place. The only vaccine currently available is nearly a century old and poorly effective. A new vaccine is needed that is at least 90 percent effective. Additionally, it is important to develop a prophylaxis for latent TB, which would work almost like a vaccine.

If you had one thing, you would ask governments to do today to improve the fight against TB, what would it be?

Dr Raviglione: Governments worldwide need to invest more in research and development for improved diagnostics, vaccines and treatment. With 620 Million USD per year, TB is badly underfunded relative to the disease burden it causes. To accelerate the improvement of existing tools, a minimum of two billion USD would be needed for R&D, although I believe we would need much more to accelerate discovery and development. Governments from low- and middle-income countries also have a role to play by investing in the overall health coverage of their population.

For World TB Day this year, I would specifically ask Germany to invest more in research, to improve the tools we have at hand and to develop new ones to fight TB. A point of care test, new drug regimens and a new and effective vaccine would be the ultimate solutions to end TB. It is truly a global fight, given the scope of global travel and the movement of people around the world – taking TB with them. What is a health threat in a far-away country today, could arrive at our front-door tomorrow.


Learn more about Imagine2030 here.

TBVI: a new TB vaccine and how to get there

As part of the Imagine2030 campaign we want to show that innovation is not just something for the future. Biomedical advances being made right now will shape how we fight diseases of poverty in the future, and are delivering changes every day. It will be these advances, and the organisations behind them, that will bring us closer to our goal: an end of diseases of poverty by 2030.


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TB Alliance: our wishes for the fight against TB by 2030, amid hope for simpler TB treatment

As part of the Imagine2030 campaign we want to show that innovation is not just something for the future. Biomedical advances being made right now will shape how we fight diseases of poverty in the future, and are delivering changes every day. It will be these advances, and the organisations behind them, that will bring us closer to our goal: an end of diseases of poverty by 2030.

For our focus on Tuberculosis in February 2017, the CEO of TB Alliance, Dr. Mel Spigelman, shares his views on how we are progressing in the fight against the disease, and his hopes for 2030. Take a look at the video, and read the dispatch fro the forefront of the fight against TB underneath!

TB Alliance: New hope for simpler TB treatment, even for the most drug-resistant cases

There are very few diseases left that are curable but still require months and months if not years of treatment. Tuberculosis (TB) is one of them, and over 10 million people are sickened by it each year.

Today’s tuberculosis treatments were developed 50 years ago. They need to be modernized. Basic treatment for TB infections that are not drug resistant lasts six months and consists of four potent antibiotics. For infections that are resistant to any or all of these four drugs, treatment is longer and much more complicated—up to thousands of pills plus injections for up to two years or more, and horrible side effects. Drug-resistant TB is a major source of antimicrobial resistance, which has emerged as an urgent global health challenge.

Current treatment doesn’t always work. According to the World Health Organization (WHO), only one fifth of those needing treatment for multi-drug resistant (MDR) TB receive it, and only half of those with who receive treatment are cured. Those with extensively drug-resistant (XDR) TB have it worse—just over one quarter of those who receive treatment are cured.

New treatments in development

Today, however, there are two experimental drug regimens that have the potential to simplify everything. Late-stage clinical trial results, presented at the Conference on Retroviruses and Opportunistic Infections in Seattle, Washington this month, gave patients and their caregivers hope for improved, shorter and simpler treatments for all types of TB, including the most difficult to treat cases.

Two new drugs—pretomanid (Pa) and bedaquiline (B)—form the backbone of these regimens. When combined with moxifloxacin (M) and pyrazinamide (Z), the BPaMZ regimen, studied in TB Alliance’s NC-005 clinical trial, shows the potential to cure all but the most drug-resistant forms of TB within six months.

When the backbone is combined with linezolid (L), the BPaL regimen, studied in TB Alliance’s Nix-TB clinical trial, shows the potential to reduce treatment time for XDR-TB from two years or more to six months—the amount of time currently needed to cure the simplest version of the disease. Expanded study of the BPaL regimen is expected later in 2017.

These results need to be confirmed in expanded studies. If the new clinical trials verify that the new treatments work, health professionals around the world will only need two versions of TB treatment—both with a simple set of daily pills to be taken for no longer than six months.

TB killed almost 2 million people in 2015. By 2030, we can solve this deadly killer.


Learn more about TB Alliance here.

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PATH: Protecting women from HIV & AIDS, and unintended pregancy

PATH staffer Cristina Butler holding a Woman's Condom female condom.
PATH staffer Cristina Butler holding a Woman’s Condom female condom.

As part of the Imagine2030 campaign we want to show that innovation is not just something for the future. Biomedical advances being made right now will shape how we fight diseases of poverty in the future, and are delivering changes every day. It will be these advances, and the organisations behind them, that will bring us closer to our goal: an end of diseases of poverty by 2030.

For our focus on HIV & AIDS in January 2017, our partners at PATH share the latest developments in the field of “dual protection” – working as they are to protect women and girls from HIV & AIDS and unintended pregnancy. Read on to find out more!


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IS Global: Innovative ideas to encourage people to access HIV & AIDS services

As part of the Imagine2030 campaign we want to show that innovation is not just something for the future. Biomedical advances being made right now will shape how we fight diseases of poverty in the future, and are delivering changes every day. It will be these advances, and the organisations behind them, that will bring us closer to our goal: an end of diseases of poverty by 2030.

For our celebration of World AIDS Day, and the role innovation has to play in fighting the disease, we profile an ongoing project by our colleagues at IS Global, the Barcelona Institute for Global Health, ISGlobal, which is an innovative alliance between academic, government, and philanthropic institutions to address the challenges in global health. Innovation is not just new products or medicines. Sometimes it is also finding new ways of doing things, improving access and using research to improve health care delivery.

Their “TESFAM” project is looking at how to keep people living with HIV in contact with health care in Mozambique. TESFAM is a collaborative project between ISGlobal and the CISM (Centro de Investigação em Saúde da Manhiça), a leading African HIV research centre, in alliance with Fundação Ariel Glaser contra o SIDA Pediátrico.


Mozambique is a country with a particularly high HIV prevalence in adults. Estimated at 10.6%, it is said to be the eighth highest in the world. In 2014, according to UNAIDS, an estimated 1.5 million people were living with HIV in the country and the mother-to-child transmission of HIV was around 12%. In Manhiça District, an area in Maputo Province in southern Mozambique, it is estimated that 40% of all adults and close to 29% of pregnant women are infected with HIV. Many of these individuals receive lifesaving antiretroviral therapy (ART), which has been available in Mozambique since 2004, due in large part to international support.

Health systems struggling with impact of HIV & AIDS

However, the magnitude of the HIV epidemic and the fact that ever more effective guidelines recommend earlier initiation of ART mean that immediate sustainability is unlikely without a huge effort to strengthen health systems countrywide. Indeed, very few health systems in the world could cope with the logistics and costs of the clinical management of 40% of the population needing lifelong care and treatment. Consequently, international collaboration and integrated efforts are essential if we are to reach the target set by the Global Health Sector Strategies for HIV, which stipulate that, by 2020, 90% of all people living with HIV will know their status, 90% of people diagnosed will be on antiretroviral therapy, and 90% of people receiving antiretroviral therapy will be virally suppressed, with the ultimate goal of eradicating AIDS by 2030.linkages

In Mozambique, ART coverage for those who need it is currently estimated at approximately 50% in adults and 39% in children, according to UNAIDS country report. These figures illustrate the sheer number of people dependent on the health system for HIV prevention and care. Despite the rapid expansion in coverage seen in recent years, over a quarter of a million adults who are eligible for ART are not receiving treatment. Stigma, overburdened health systems and poverty present daily challenges to retention in care and treatment.

TESFAM – getting people care they need

The objective of the Tesfam study, which focuses on the Manhiça district, is to give more people access to HIV testing, link them to care, and retain them in care and treatment. The study compared clinic-based and home-based HIV testing and counselling approaches, comparing rates of linkage to care and cost-effectiveness. Ultimately, the hope is that the findings of Tesfam will optimize HIV counselling and testing strategies, leading to the engagement of as many people as possible in the care cascade. hiv-cascade

 

Over the course of the study, approximately 16,000 adults were offered HIV testing. Of those eligible for the study, almost 15% already knew their HIV-positive serostatus. The 1,122 adults identified as new HIV diagnoses were enrolled for follow up. A key step in the cascade from testing to treatment is the CD4 test to determine eligibility for ART. In the Tesfam study, at 3 months post diagnosis, only 43.7% of those enrolled had undergone CD4 testing  (see Figure 2).

Despite increased rates of HIV testing, loss to follow up at each step in the HIV care cascade is very common in both resource-constrained settings and in more resource-rich countries. The reasons why patients drop out of the HIV care cascade are very complex and are influenced by multiple factors relating to the healthcare system and the individual, including socioeconomic profile. Standard of care in many sub-Saharan African settings does not include routine patient tracing, and the fate of individuals lost to follow-up is largely unknown. Since the HIV-infected population is especially vulnerable to illness and early death, it is important that these patients are traced and re-engaged into care. The design of the Tesfam study included home visits and counselling for the 850 individuals who abandoned treatment at different phases of the cascade. While some had migrated or died, the home visit was very effective at re-engaging a large proportion of the 468 patients who received this additional visit. Moreover, these patients were interviewed to ascertain why they had dropped out of the study.

tesfamRaising awareness of HIV treatment – community engagement

One of the main contributions of the Tesfam project in Manhiça was that it raised awareness in the community of HIV and HIV treatment through organised community events and presentations at public markets to discuss the obstacles and solutions relating to accessing HIV/AIDS care and treatment. These sessions are dynamic and enriching discussions led by an experienced counsellor. Community members actively participate by presenting their concerns and offering suggestions on ways the barriers to adherence to care for HIV-positive patients could be overcome. These events bring the community together to discuss the best approaches to HIV/AIDS care and treatment and health-seeking behaviour and to emphasise the importance of HIV testing, prevention and transmission mechanisms. The discussions brought to light various reasons why people do not go to the hospital for testing or treatment, such as a lack of time and the fact that they do not feel comfortable with the hospital staff.

Finally, community participation can reduce stigma and give people an opportunity to share their views on HIV/AIDS programmes and contribute to their improvement.  In this respect, the Tesfam project clearly identified a need for a better understanding of the barriers and facilitators of retention in care. Local leaders were also shown to have considerable influence on the behaviour of members of their communities.

In the future, more efforts aimed at retaining and re-engaging patients in care will be crucial. A few weeks could mean the difference between life and death. In addition, there is a great need to train health care workers to create a non-judgmental enabling environment. There is no one-size-fits-all approach, and in order to achieve the 90-90-90 target we must adapt our strategies to different settings and cultures so that all HIV-positive individuals are diagnosed, linked and retained in care. This challenge can only be met by intervening at various stages of the HIV care cascade.


Learn more about IS Global here.

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