Tools to Turbocharge the Fight Against Tuberculosis

By The Global Fund

September 10^th, 2023

Tuberculosis (TB) remains one of the deadliest infectious diseases in the world, killing over 1.5 million people every year.

Even more devastating is that TB is preventable, treatable and curable – but too often people most at risk can’t access the tools and resources that exist to protect themselves or get timely treatment.

From the newest diagnostic technology to innovative treatments for adults and children, there is an incredible arsenal of resources that exist in the fight against TB.

World leaders meeting at the United Nations General Assembly have an incredible opportunity to turbocharge the fight against TB by tackling the deep-rooted inequalities that fuel TB and ensure everyone has access to these proven, lifesaving tools.

An all-in response today will not accelerate the fight against TB, but will also help build a safer, healthier and more equitable world for everyone tomorrow.

Shorter, Life-changing Treatment for Drug-resistant Tuberculosis

Tools to Turbocharge the Fight Against Tuberculosis

Imagine being diagnosed with drug-resistant TB. You begin a brutal course of treatment that can last up to 24 months. You experience harsh side effects like muscle weakness, permanent hearing loss, numbness in the toes and fingers, depression, suicidal thoughts and even psychosis.

But it shouldn’t be like this anymore.

The World Health Organization (WHO) recently released updated guidelines to treat drug-resistant TB. They now recommend a 6-month all-oral, injection-free treatment regimen composed of four medicines – bedaquiline, pretomanid, linezolid and moxifloxacin (BPaLM).

The BPaLM regimen represents a huge milestone in drug-resistant TB care: By drastically reducing the duration of treatment, patients are more likely to finish it, suffer fewer debilitating side effects and be cured of the disease for good.

Using Artificial Intelligence to Rapidly Read Chest X-rays

In places where people face an increased risk of TB – poor urban settlements, camps for displaced people or conflict zones – having a skilled radiologist available to read a chest X-ray isn’t always possible. Without proper screening, TB patients will continue to be missed and the disease will continue to spread.

But artificial intelligence (AI) has the potential to revolutionize the way X-rays are read. Right now, there are a number of computer-aided detection tools that rely on AI to rapidly and accurately read X-rays to find TB. In addition to screening for TB, a recent study found AI was able to save on costs by rapidly reading X-rays to determine if further, and costly, testing was needed or not. AI has the potential to be a game-changer in the fight against TB.

TB Diagnosis on Wheels

A huge challenge in the fight against TB is being able to detect the disease in hard-to-reach areas, including places impacted by conflict and displacement.

Mobile diagnostic units – or vans that have been converted to include cutting-edge tools that detect TB – help solve this problem. These vans can drive to the places where they are needed most. Once aboard the van, people receive a chest X-ray and may be asked to give a sputum sample, which a clinician then feeds into a GeneXpert or Truenat™ test that can quickly detect the presence of TB.

Bringing these mobile services directly to the community is a powerful tool to stop TB in its tracks: More people with TB can be found, diagnosed and referred for treatment.

Surveillance Through Whole Genome Sequencing

Whole genome sequencing is a cutting-edge laboratory method that determines the DNA sequence of an organism’s genetic details. In the fight against TB this sequencing technology can be used as a vital surveillance tool – to rapidly determine TB transmission and help identify mutations that lead to drug resistance. Rapid identification of TB can result in a rapid response to halt the spread of the disease by getting people on treatment as fast as possible.

But like many of the tools used to fight TB, whole genome sequencing can be used to fight other diseases as well, including COVID-19. By investing in whole genome sequencing for TB surveillance, we are simultaneously fighting other diseases and preparing for future health threats.

"Poop" Diagnostics and Fruity Flavor Treatments for Children

Every year around 1 million children under the age of 15 will get TB and more than 200,000 will die from it.

Diagnosing and treating TB in children can be challenging. Symptoms are often similar to other childhood illnesses and collecting specimens can be difficult. Young children can’t produce sputum when asked, so the only way to get a sample is through a painful nasal tube. But TB can now be diagnosed in children using stool samples – which are easy and painless to collect.

Children with TB may need to be on medication for up to nine months and giving medicines to young children is never easy. Fortunately, there are a number of child-friendly TB medications that come in the correct dosage, are liquid (so easier for parents to dispense), and are available in fruity flavors.

Drug-resistant TB Treatment at Home

Treatment for drug-resistant TB can involve long hospital stays or frequent trips to a clinic for months or even years, forcing people to miss work or other important commitments. Too many people are faced with the impossible decision to either seek treatment for a killer disease or lose their livelihood.

Today, there’s another way.

Digital adherence technologies (DATs) – like medication sleeves, smart pill boxes and video-supported treatment – make it possible for people to take their medications where and when they want to, while remaining safely connected to their health care provider.

Placing the person at the center of the treatment response is transformative. By decentralizing drug-resistant TB treatment from health facilities into communities and homes, there are far fewer barriers for people to beat the disease.

Screening and Testing for More Than One Disease at the Same Time

When the COVID-19 pandemic hit, critical resources were diverted from the fight against TB to respond to the new respiratory illness that took the world by storm.

Many countries used the best assets in the fight against TB to combat COVID-19, including community health workers, laboratories, diagnostic equipment, disease surveillance systems as well as other investments.

For example, GeneXpert and Truenat™ tests facilitated integrated TB and COVID-19 screening programs and laboratory services. Bidirectional testing – or screening for both diseases at the same time – has the power to stop the onward transmission of both diseases and ensure that people with TB are diagnosed, treated and cured.

Integrated testing is now becoming a primary tenet of many countries’ pandemic preparedness and response plans.

A New Vaccine – We Did It for COVID-19; Now It’s Time for TB

We need a new TB vaccine. Now.

An effective, affordable and equitably distributed vaccine has the power to save millions of lives. What’s more, Gavi, the Vaccine Alliance says that an effective new TB vaccine could produce up to US$474 billion in economic benefits by 2050.

The Bacille Calmette-Guerin (BCG) TB vaccine, which has been around since 1921, does not offer adequate protection. In fact, the majority of the 10 million people who fell ill with TB in 2021 – and the 1.6 million people who died from it – received the BCG vaccine.

There was incredible global momentum to find a COVID-19 vaccine. That same level of urgency must propel the development of a TB vaccine today.

We’re on the right track: With 16 TB vaccine candidates currently under development, increased investments and political commitment could lead to a real breakthrough in TB prevention and save millions of lives.