During the month of May, IMPACT will be highlighting USAID’s work in Global Health. From May 1-10, we will be featuring the role that Science, Technology & Innovation plays in Global Health.
In 1882, Dr. Robert Koch discovered Mycobacterium tuberculosis, the bacteria that causes TB. In 1952, the first combination of antibiotics was used to treat. Today, thoughout the world, most people with TB are diagnosed with the same simple microscopy method that Koch used to identify the bacteria. Additionally, almost all are treated with the same basic antibiotics that have been used since mid-20th century. During the same time period, the HIV epidemic and spread of drug resistant TB have complicated diagnosis of TB. People with HIV who become sick with TB are less likely to be diagnosed correctly using simple microscopy, and this technique does not tell us whether or not the bacteria is resistant to anti-TB drugs. Moreover, with the alarming increase in drug resistant cases in recent years, we see the limits of available treatment. The drugs used to treat multi-drug-resistant TB are not very effective and extremely toxic, and patients must take them for up to two years to achieve cure.
But the past decade has brought significant new tools to the fight against TB, including the Xpert MTB/RIF® diagnostic platform and potential new regimens to shorten the length of treatment. The Xpert test for TB diagnosis can tell us whether or not a person has TB AND whether or not the bacteria is resistant to Rifampicin, one of the most powerful anti-TB drugs, in less than two hours. Without Xpert, it can take up to two months to confirm drug resistance, which results in a long delay in starting appropriate treatment. Xpert is a relatively simple test that can be implemented with minimal training and infection control requirements, and recent negotiations with the manufacturer have resulted in a significant decrease in the price. The US government is supporting countries in regions with high HIV prevalence and high levels of drug resistance to introduce and implement this new diagnostic test.
On the treatment side of the equation, the U.S. government is supporting late stage research to test new regimens for multi-drug resistant TB that will reduce the treatment time from 18 to 24 months to 6 to 9 months. Additionally, we are working with global leaders to develop guidelines for the introduction of bedaquiline, the first new anti-TB drug in 50 years, to existing treatment regimens.
Despite these promising new tools, we need additional point of care TB diagnosis tools and shorter, less toxic regimens to reduce the treatment time even further and with fewer side effects, which can be debilitating for those on treatment for drug-resistant TB. The U.S. government will continue working with global leaders, national TB programs, civil society and at community level to support this critical work in the fight against tuberculosis.
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