Increased investment in evidence-based interventions to diagnose, treat, and prevent tuberculosis (TB), especially in high-burden countries, could help end TB within a generation, researchers found.
Not only should these interventions be scaled up, but greater investment and research is needed to develop new methods of diagnosis, treatment, and prevention around the world, reported Michael J A Reid, MD, of the University of California, San Francisco, and colleagues.
Moreover, the responsibility for investing in TB programs should be shared between domestic allocation in these countries, as well as external funding through increased developmental assistance, the authors wrote in The Lancet.
To reach these goals, global investment in TB research and development will need to increase to at least $2 billion per year during the next 4 years, they noted.
In September, the United Nations held its first-ever “high-level meeting” about TB, with the goals of treating 40 million people and preventing 30 million new cases from 2018-2022. This new report says that a TB-free world is possible by 2045 if “increased political will and financial resources” are targeted towards areas where they are needed most.
Indeed, the authors argued that the savings from averting a TB death can be three times the costs in certain countries. They used the example of India, the country with the highest burden of TB, saying “unavoidable tuberculosis deaths” will cost the country at least $32 billion each year over the next 30 years, even with “optimal implementation of existing tools.”
“We should be implementing evidence-proven strategies we know work,” Reid said in a separate video interview with MedPage Today. “That involves delivering patients into care, scaling up access to prevention interventions, making universal access to drug susceptibility testing, and [making] second-line drugs universally available.”
The World Health Organization (WHO) report on TB in September found gaps in treatment, especially for multi-drug resistant TB, estimating that 558,000 people have resistance to first-line treatment, and only one in four people with a resistant form of TB had access to treatment.
In this report, Reid and colleagues cited the example of Moldova, where 25% of all TB cases are drug-resistant, and improving access to drug susceptibility testing could cut mortality from drug-resistant TB by 44%.
Delivering patients into care is another key component. Modeling data shows that “[optimizing] private sector engagement” in India could prevent 8 million deaths from TB from 2019-2045, the authors said. They added that combatting TB also means reaching high-risk populations, such as those with TB and HIV co-infection, estimating that in a country such as Kenya, scaled up access to both antiretroviral therapy and TB therapy could save an additional 3 million lives.
This war will be waged on two fronts — both domestically in high-burden countries, and through developmental assistance through donor agencies, the private sector, and foundations, the authors said. The report states that countries like Bangladesh, China, Indonesia, and Zambia “can increase their annual expenditures more than five-fold over the next 5 years through increased revenue generation and allocation of greater budgetary resources to health.”
An accompanying editorial by Elizabeth Zuccala, PhD, and Richard Horton, FRCP, both Lancet editors, characterized the report as providing “a rare opportunity to reinvigorate the fight against tuberculosis.”
“Meeting global goals will require a sweeping realignment of global and national priorities […] towards committing to funding the interventions and research that are needed most,” the editorialists wrote. “People affected by tuberculosis are often among the most poor, [marginalized], and [stigmatized] in their communities, and it is hard to escape the conclusion that the chronic underfunding and underappreciation of tuberculosis are reflections of their social and economic status.”
Reid told MedPage Today that the plan requires engaging stakeholders across different sectors, and that “new and innovative ways” of financing the fight against TB are needed.
“That involves … emphasizing the importance of global accountability and recognizing that TB survivors and their advocates are an essential constituency that we can’t neglect and must include in all policy-related decisions,” he said. “In order to end TB, we need to create that enabling environment that will drive down incidence and mortality.”
Reid disclosed no relevant relationships with industry. Co-authors disclosed support from Merck, Otsuka, the NIH, the CDC, the Gilead Foundation, the U.S. Agency for International Development (USAID), the Wellcome Trust, the South Africa National Research Foundation, the UK Medical Research Council, Gilead Sciences, World Bank, UNAIDS, the Rush Foundation, the Bill & Melinda Gates Foundation, New York University, the WHO, the Global Fund to Fight Aids, Tuberculosis and Malaria, the Stop TB Partnership, Unitaid (via Aurum and the Elizabeth Glaser Pediatric AIDS Foundation), the Veterans Administration, Harvard University, the Stony Wold-Herbert Foundation, the National Institute for Allergy and Infectious Diseases, the National Institute of Child Health and Human Development, the University of California San Francisco, San Francisco General Hospital, the Johns Hopkins University Center for AIDS Research, and Johnson & Johnson.
One co-author is a member of the US Adult AIDS Clinical Trials Group Tuberculosis Transformative Study Group of the protocol team of the forthcoming PHOENIx MDR-TB (Protecting Households On Exposure to Newly Diagnosed Index Multidrug-Resistant Tuberculosis Patients) trial, of the Scientific Advisory Board of the John Hopkins University Center for AIDS Research, and of the PEPFAR Scientific Advisory Board of the Office of the Global AIDS Coordinator.
One co-author is a member of the British Parliament and co-chair of the Global TB Caucus. One co-author is a member of the WHO’s Strategic and Technical Advisory Group for Tuberculosis Committee, the Access Advisory Committee of TB Alliance, and the Scientific Advisory Committee of FIND. One co-author disclosed a patent. One co-author is a senior associate of Linksbridge, which provides consulting services to the Bill & Melinda Gates Foundation.
Zuccala is senior editor and Horton is editor-in-chief of The Lancet.