Digital Adherence TechnologiesAccording to a report by the World Health Organization, more than 80% of tuberculosis (TB) cases and deaths were associated with low and middle-income countries in 2022. Common poverty conditions, such as crowding and inadequate ventilation, were found to contribute greatly to its spread. 

To treat tuberculosis, patients are required to undergo months of antibiotic therapy. Directly observed therapy (DOT), is a widely employed strategy that relies on confirming patient adherence to treatment protocol, where health care workers observe patients taking anti-TB medication. However, DOT requires significant time and resources for health care providers and patients. Digital Adherence Technologies (DATs), on the other hand, are digital tools (internet, phones, computers, or detectors) that allow patients to take their medication at their convenience while adherence is relayed to healthcare providers without direct observation. As a modern strategy to combat TB, DATs can help affected individuals and families from a wide range of income levels by reducing implementation costs over time.

Types of Digital Adherence Technologies

Several types of DATs can be implemented to improve TB treatment outcomes:

  1. Medication sleeves/labels are a form of custom packaging on fixed-dose anti-TB medication that contains a unique code the patient can use to report adherence. After removing a pill, the patient is required to call a toll-free phone number or send a free SMS message to submit the code and prove daily consumption. This DAT was first implemented in India and is now used throughout Bangladesh, the Democratic Republic of Congo, Ethiopia, Myanmar, Nigeria, the Philippines, Tanzania and Uganda. 
  2. Equipped with a sensor and mobile data connection, Smart Pill Boxes alert healthcare providers to patient medication adherence whenever they are opened. This DAT includes features such as a rechargeable battery and a LED and/or speaker to enable reminders and has been implemented in 20 countries with varying income levels, including Brazil, Mozambique, and China.
  3. Video Supported Treatment (VAT) requires patients to use a secure remote application to record then upload videos of themselves ingesting medication that the provider can later access. This DAT has been implemented in 17 countries, spanning across Asia and Africa.

DATs have varying costs, levels of accessibility and ease of implementation. Poverty, resource limitations and insufficient infrastructure can pose challenges to implementing these technologies. Medication sleeves require phone access and communication infrastructure to support phone calls or text messages. Smart pillboxes require adherence platform access but are user-friendly and work with various pill types. VATs require phone access, mobile data or Wi-Fi and an in-country server to store video files yet are considered suitable for use with different drug types.  These requirements help determine the logistics of implementing a DAT for a specific country.

Implementing Digital Adherence Technologies

The Stop TB Partnership and the ASCENT Project are two organizations among many that continually research and implement digital adherence technologies for tuberculosis treatment. The Stop TB Partnership funded the implementation of medication sleeves and video-observed treatment in Nigeria, where tuberculosis rates are high, from October 2021 to August 2022. According to a December 2023 report, more than 7,600 patients received digital adherence technologies through this project. Patients achieved success with a medication sleeve called 99DOTS, but limited access to smartphones and network difficulties hindered the success of video observed treatment. The project highlighted the importance of digital adherence technologies with low technology requirements, especially in remote locations. 

In 2021, the ASCENT project, organized and funded by Unitaid, began implementing smart pill boxes and medication sleeves in Ethiopia, a low-income country with a high tuberculosis burden. The project provided more than 4,000 people with DATs. In November 2023, the ASCENT team reported broad acceptance of the technologies among patients with tuberculosis, high national support, and concerns regarding costs. The project also revealed ways leaders could improve and increase the use of digital adherence technologies in Ethiopia in the future. 

Conclusion

Digital adherence technologies offer several strategies to support tuberculosis patients through months of medications. Implementing these tools in areas of poverty presents challenges to overcome, including limited resources and frail infrastructure. To this end, organizations will continue to implement, research, and improve the use of DATs for tuberculosis treatment around the world.

– Kelly Carroll
Photo: Flickr

Global Health ChallengesEvery September, one of the most important days on the foreign policy agenda is the United Nations General Assembly (UNGA). World leaders and representatives of all United Nations member states gather to tackle pressing global issues. 

As we approach the midway point of the Sustainable Development Goals (SDGs) set for 2030, the 78th UNGA session has emphasized rebuilding strong international agreements to address global safety, health and peace concerns. Dennis Francis, President of the General Assembly, declared the UNGA will work toward “rebuilding trust and reigniting global solidarity: accelerating action on the 2030 Agenda and its Sustainable Development Goals towards peace, prosperity, progress and sustainability for all.” Here is how the UNGA is responding to global health challenges.

UNGA’s Response to Global Health Challenges

The World Health Organization (WHO) urged leaders and members of the UNGA to prioritize global health as an urgent topic requiring immediate attention. UNGA scheduled three high-level meetings on global health: Pandemic prevention, preparedness and response (PPPR), Universal Health Coverage (UHC) and the fight against tuberculosis (TB). 

Pandemic Prevention, Preparedness and Response (PPPR)

Under the overarching theme of “Making the World Safer,” the PPPR, buoyed by the momentum from the COVID-19 pandemic, has been met with greater urgency and prominence. UNGA structured the discussion of PPPR in two distinct panels: one focused on governance and accountability, ensuring all stakeholders, both public and private, uphold their commitments to PPPR; the other centered on building capacity and securing innovative and sustainable equity in the PPPR process. These themes address different facets of the broader PPPR framework, contributing to a holistic and equitable recovery strategy. The outcome of this meeting was a declaration mobilizing political commitment at local and international levels to address pandemic risks and responses. 

Universal Health Coverage (UHC)

The document outlining the UNGA agenda covered health outcomes, primary health care–oriented systems and essential public health functions. It renewed the declaration of 2019: “Universal health coverage: moving together to build a healthier world.” The existing agreements to further UHC have made huge impacts — between 2013 and 2020, health care workers increased by 29% globally. The 2023 meeting identified steps toward meeting the goal of universal health coverage by 2030. 

The Fight Against Tuberculosis (TB) 

UNGA holds this meeting with the goal of “advancing science, finance, and innovation and their benefits to urgently end the global tuberculosis epidemic, in particular, by ensuring equitable access to prevention, testing, treatment, and care.” The UNGA revisited the 2018 tuberculosis target declaration of the first General Assembly high-level meeting. Attendees brought forward plans to advance and end the tuberculosis epidemic by 2030. With 1.6 million deaths annually, the discussion highlights the need for stronger integration of affordable access to TB services. 

Health as an Investment

The World Health Organization advanced the principle that “health is an investment, not a cost.” Embracing this notion carries profound implications, especially for those living in poverty. The 78th UNGA addressing global health equity represents a change within the global agenda. By recognizing health as an investment, global governance takes a more holistic approach to discussing global health equity, contributing to broader health goals and addressing global health challenges. A healthy population can participate in education, employment and community — fostering economic growth. Commitment to this principle is vital to navigate the path toward a healthier future for all.

Bella Oliver-Steinberg
Photo: Flickr

Affordable Tuberculosis Treatment
On September 29, 2023, Johnson & Johnson (J&J) announced that it would not enforce patents in 134 low- and middle-income countries for Sirturo — its brand name for bedaquiline tuberculosis treatment. This change is an exciting step toward providing generic, affordable tuberculosis treatment to people who desperately need it. 

Patents and Medication Prices

Patents can keep the cost of life-saving medications out of reach for many – especially those in poverty. So why do medications have patents? Pharmaceutical companies must undergo a rigorous testing process through the FDA to ensure the drugs are safe enough to go on the market. They obtain a patent to protect their research, which the FDA requires before approval. Once this patent is obtained, pharmaceutical companies must undergo a five-step process: 

  1. Discovery. 
  2. Preclinical research.
  3. Clinical research.
  4. FDA review.
  5. Post-market safety monitoring. 

More than 90% of drugs do not make the cut — most fail because they either do not adequately treat the condition or because they cause side effects that are too debilitating.

It takes about 10 years for a new drug to complete the five-step process toward FDA approval, costing an estimated $2.6 billion. Considering that 90% of medications are not approved, pharmaceutical companies try to recoup their investment by passing that cost onto consumers. Innovation of new medications used to be the goal of pharmaceutical companies, but with the increased costs of research and development, they shifted their focus from innovating new medications to capitalizing on existing medications. Over the past five years alone, the average cost of medications has increased by more than 71%.

Rising Costs of Medications

Patents prevent the development of generic alternatives to medications. When pharmaceutical companies shifted their focus toward capitalizing on existing medications, they started proactively renewing drug patents to ensure generic alternatives could not be developed. Without competition on patented medications and no federal oversight on drug prices, pharmaceutical companies can set the price of life-saving medications as they see fit.

This decision is particularly devastating for developing countries. Even when generic alternatives are available, research has found that developing and poverty-stricken countries often pay more than others.

“Developing countries are often paying far more for everyday drugs than they should be. Why do some poor countries pay 20 to 30 times as much as others for common medicines to relieve pain or treat hypertension? In large part, because of flawed drug buying practices and broken generic medicines markets,” said Amanda Glassman, the executive vice president at the Center for Global Development.

Without generic medications, affordable health care is out of reach for developing countries, and people are paying the price for their health. Even when generic medications are available, there is little regulation of prices. 

Tuberculosis and Poverty

Poverty is a huge determinant of tuberculosis. Tuberculosis risk factors are rampant in the poorest communities: overcrowding, malnutrition, inadequate ventilation and limited general health and disease prevention knowledge.

Given the prevalence of tuberculosis risk factors in poverty-stricken communities, the need for generic tuberculosis medications is a lifeline most vulnerable communities need now more than ever. This need is why Johnson and Johnson’s announcement that they will not enforce patents on their patented TB medication is a step in the right direction. The hope is that this will pave the way for affordable tuberculosis treatment by allowing the development of generic, more affordable alternative drugs.

“The decision is intended to assure current and future generic manufacturers that they may manufacture and sell high-quality generic versions of Sirturo without a concern that the company will enforce its bedaquiline patents, provided the generic versions of Sirturo produced or supplied by generic manufacturers are of good quality, medically acceptable and are used only in the 134 low- and middle-income countries,” J&J said.

– Ann-Jinette Hess
Photo: Flickr

Generic BedaquilineFollowing recent negotiations between the Johnson & Johnson company and the Stop TB Partnership, generic bedaquiline will become available and affordable to millions of people. Bedaquiline is a crucial medication in treating multidrug-resistant tuberculosis which affects hundreds of thousands of people per year. Johnson & Johnson held a 20-year primary patent on the drug which was set to expire on July 18, 2023. 

Unaffordable Treatment

Hundreds of thousands of people globally contract multi-drug resistant tuberculosis with an estimated 450,000 in 2021 alone. While tuberculosis is relatively treatable, the vast majority of deaths from the disease occur in the global south due to unaffordable treatment pricing. As a result of the Johnson & Johnson patent on bedaquiline, tens of thousands of people were unable to afford life-saving treatment for tuberculosis. 

Despite being largely treatable, thousands of people continued to die from the disease due to this lack of access and affordability. The global south, experiencing higher rates of multi-drug-resistant tuberculosis, was particularly impacted. Despite this, Johnson & Johnson continued to apply for ‘secondary’ patents in countries around the globe. As a result, numerous organizations including Doctors Without Borders (MSF) called upon Johnson & Johnson to withdraw any ‘pending secondary patents’ and not enforce any approved secondary patents ‘for the drug in any country with a high burden of TB.’ If agreed upon, this arrangement could save thousands of lives within a short period.

Successful Negotiations

Following said negotiations between Johnson & Johnson and the Stop TB Partnership, the Global Drug Facility (GDF) was granted the licenses to procure and supply generic versions of bedaquiline to a majority of low or middle-income countries that are most impacted by the disease, including some countries where Johnson & Johnson’s patents remain in effect. However, this agreement is only a ‘partial solution.’ It doesn’t apply across the board and Johnson & Johnson still holds secondary patents in 34 of 49 countries most impacted by tuberculosis. Nevertheless, it could still have a massive impact globally on thousands of people who can afford treatment. 

A Collective Effort

The availability of generic bedaquiline can potentially save thousands of lives. This also highlights the importance of putting pressure on companies and governments to ‘do the right thing.’ Organizations like Doctors Without Borders have been instrumental in persuading Johnson & Johnson to allow cheaper and more accessible tuberculosis treatment to be produced and circulated. It also shows the impact of individuals like popular YouTuber and author John Green who used his influence to spread information about the situation and negotiations, encouraging his followers to contact Johnson & Johnson about their views on a recent YouTube video that was viewed more than 1.3 million times. 

The agreement between Johnson & Johnson and the Stop TB Partnership likely benefited from the involvement of various organizations and individuals who shared their perspectives and advocated for this collaboration. This cooperative effort demonstrates the influence of collective voices in advocating for the interests of many. Consequently, the Johnson & Johnson bedaquiline agreement represents a significant advancement in ensuring accessible and effective care for numerous individuals, showcasing the impact of advocating for the needs of the broader community.

– Jaydin Ruch
Photo: Unsplash

USAID Support
Vietnam, officially known as the Socialist Republic of Vietnam, is located in Indochina, an eastern peninsula edge of Southeast Asia. Vietnam’s bordering countries consist of Cambodia, China and Laos, and is an important partner for the United States (U.S.) in terms of trade. The country is reputable for its fertile grounds and deltas, providing its population with abundant resources to grow crops. Vietnam is also one of the few countries with the highest cases of tuberculosis in the world. With the help of a national program and USAID support, Vietnam is on track to combat tuberculosis.

Tuberculosis Endemic in Vietnam 

According to the Pulitzer Center, tuberculosis is often treated successfully once diagnosed in patients; however, efforts to detect and prevent the disease in Vietnam are deficient by comparison. Reasons for poor prevention and detection can be attributed to the country’s overall economic state. Being able to effectively combat tuberculosis means having the resources to provide education about the disease, sufficient tests and medication. 

If the disease continues to reach more people and evolve, there is concern that a stronger form of the disease, MDR-TB may become more widespread. MDR-TB, or Multidrug-Resistant TB, is a type of tuberculosis that is resistant to the most potent drugs typically used to treat the disease (Isoniazid and Rifampin). MDR-TB has a higher mortality rate than normal tuberculosis. According to Vietnam’s WHO medical officer, tuberculosis is a neglected disease, even with a chunk of financing provided by The Global Fund. This is because most of the funds are directed toward HIV and malaria efforts rather than tuberculosis. 

The concern of tuberculosis is not limited to those within Vietnam but also extends to foreigners who travel from developed countries. In the West, there is an attitude about tuberculosis that points to a lack of concern since the disease doesn’t pose a major risk amongst developed nations. Therefore, unaware travelers may increase the risk of bringing more strains of tuberculosis to Vietnam. 

Vietnam’s Government and Programs

Vietnam’s National Tuberculosis Control Programme (NTP) originated in 1986 with guidelines including standard protocol treatment across the nation, tuberculosis control systems incorporated into the country’s primary health care system and diagnostic direct smear examinations. 

Further, the formation of the NTP meant communal health workers within various districts were trained and received treatment and detection supplies. As a result, around 99% of Vietnam’s communities utilized the NTP policies and regulations by the year 2000. The national program gained traction in the late 1900s and was eventually given priority amongst national health care programs, further receiving support from the Dutch government. 

Vietnam has also developed a national commission for resources which fosters collaboration amongst various sectors to end tuberculosis. Vietnam’s goal is to end tuberculosis by 2030, and in order to do so, the country is committed to strengthening its technological and scientific innovations. 

To create better access to tuberculosis care, Vietnam’s government decided to provide insured services for tuberculosis patients in all provinces of Vietnam. To achieve this, the government widened the Social Health Insurance plan to cover tuberculosis treatment and prevention. In 2022, Vietnam’s Social Health Insurance covered all expenses related to tuberculosis. 

USAID Support

USAID is providing assistance in fighting tuberculosis through Vietnam’s National Tuberculosis Program by effectively implementing diagnostic strategies of Double X, which consists of a rapid detection instrument and a chest X-ray. The rapid detection technology, Xpert MTB/RIF, has a high level of sensitivity compared to conventional sputum smears. Xpert MTB/RIF identifies the bacteria Mycobacterium tuberculosis or MTB as well as resistance to rifampicin, an antibiotic used to treat mycobacterial infections. 

Traditionally, tuberculosis detection tools involve sputum smears, a test that measures a type of bacteria, acid-fast bacilli (AFB), which causes the disease. However, traditional sputum smears lack sensitivity compared to rapid detection technology in that confirmation of tuberculosis requires at least 10-100 AFB/ml. 

Among seven provinces, one that has benefited from USAID support in combating tuberculosis is An Giang, a southern region in Vietnam. An Giang has one of the highest cases of tuberculosis, and in executing the Double X plan of action, a few districts in An Giang province have experienced higher tuberculosis detection. In 2020, patients within three districts in An Giang were tested using the innovative X-ray and detection tools of Double X, leading to more than 80% increase in the detection of tuberculosis within the province since 2019. 

In order to effectively implement Double X, the USAID Sustainable HIV and Tuberculosis Response from Technical Assistance (SHIFT) collaborated with Vietnam’s NTP to train health care professionals in health facilities, focusing on areas in Vietnam with patients, not within the NTP system such as those with respiratory symptoms, diabetes or pneumonia. 

Results from these studies and the implementation of the Double X program show the efficacy and impact these tools have. The USAID support in technology and science dedicated to early detection of tuberculosis evidently has made a difference in Vietnam’s goal to end tuberculosis by the year 2030. 

Looking Ahead  

It is evident that Vietnam’s national and governmental efforts to combat the tuberculosis endemic have resulted in innovations in detection, prevention and treatment tools. The USAID/SHIFT implementation of the Double X strategy in collaboration with the NTP has been essential in accelerating and assisting the country’s goal of ending tuberculosis by 2030. 

Bianca Roh
Photo: Flickr

Diseases Impacting UgandaFor Uganda, a country in East Africa, health is a major concern. Uganda’s population of 47 million has always been heavily impacted by illness and disease, with communicable diseases accounting for over 50% of deaths in the country. Malaria, tuberculosis (TB) and HIV/AIDS are three of the top diseases impacting Uganda and are among the leading causes of death. 

Here is more information about these diseases, and what is being done about them.

Malaria

Malaria is a life-threatening disease spread through mosquitoes that feed on humans, with symptoms such as high fevers and shaking chills. As one of the top diseases impacting Uganda, it is a risk to over 90% of the Ugandan population and is a leading cause of sickness and death, especially in children. Uganda has the highest malaria incidence rate worldwide, with 478 cases per 1,000 people per year, and malaria is estimated to have caused between 70,000 and 100,000 deaths per year, exceeding even the death rate of HIV.

In Uganda’s Ntungamo District, one of the districts most heavily affected by malaria, people have taken action to combat its spread. Village Health Teams (VHT) have been trained by the Ministry of Health and UNICEF to support Ugandan communities in fighting against diseases and assisting health care workers in providing health services. The teams also educate communities on malaria prevention methods, such as insecticide-treated mosquito nets, and prescribe Coartem, an anti-malarial medication that destroys the malaria parasites, to those affected by malaria. The efforts of the VHT have resulted in a remarkable decline in malaria cases — from 8,297 cases in December 2022 to 3,995 cases in March 2023. 

Tuberculosis

TB is an infectious disease that mainly affects the lungs. It is caused by a type of bacteria and is spread through the air when TB-infected people cough. TB is a leading cause of death worldwide, and Uganda is one of the countries with the highest burden of TB. Every day, around 30 people die of TB, and 240 people fall sick with TB in Uganda. Uganda is designated by the World Health Organization to be a TB and HIV high-burden country, with over 12,000 deaths to TB every year, and around half of those deaths are among those who are HIV-positive. Children under 15 account for an estimated 12% of TB cases, with young children vulnerable to developing a more severe version of TB. 

Since 2015, the Ugandan government has made significant progress in improving the coverage of TB preventive treatment that targets those living with HIV, made available at no cost for TB patients. Scaling up the coverage of preventive treatment has resulted in nearly 600,000 people living with HIV initiating this treatment from 2015 to 2019, and from 2016 to 2022, TB preventive treatment coverage for people living with HIV increased from 0.6% to 88.8%. Over the years, Uganda has successfully scaled up the provision of TB preventive treatment to those living with HIV, and the government has pledged to end TB by 2030 by continuing to accelerate the delivery of TB treatments.

HIV/AIDS

Acquired immunodeficiency syndrome (AIDS) is a condition caused by the human immunodeficiency virus (HIV). HIV attacks the human immune system, leaving it vulnerable to infection and disease. Around 1.4 million people in Uganda live with HIV, among whom women are disproportionately affected. About 17,000 people die per year due to AIDS, 22% of whom are children under the age of 15. 

The nonprofit organization mothers2mothers (m2m) contributes to the prevention of mother-to-child transmission of HIV and has virtually eliminated mother-to-child transmission of HIV among its clients. It supports mothers who live with HIV by helping pregnant women access antiretroviral treatment (ART). In 2021, m2m took in and improved the lives of over 150,000 new clients; among these clients, 100% of HIV-positive women have been given lifetime ART, and 100% of HIV-exposed infants have been treated with ART as protection from infection. m2m has also intervened to end child marriage in Uganda’s Kamuli District, protecting adolescent women who are more susceptible to getting infected and increasing access to HIV care. 

Looking Forward

The measures taken to combat some of the most deadly diseases impacting Uganda have led to a decrease in mortality rates over the years. With continued efforts from organizations like m2m and local communities, Uganda will continue to make strides in minimizing the impact of malaria, TB, HIV/AIDS and other diseases. 

– Stephanie Chan
Photo: Unsplash

TB in IndiaGlobally, India contributes the largest number of tuberculosis (TB) cases yearly, totaling more than half a million deaths in 2021. In response, Prime Minister Narendra Modi has declared war on the disease, aiming to end TB in India by 2025, five years ahead of the global goal of 2030 set by the World Health Organization (WHO)

However, this is no easy feat to accomplish for India. Poor sanitation and crowded areas greatly increase the risk of transmission — a harsh reality for India with 1.4 billion people and 1/10 living below the poverty line. Furthermore, a lack of stable infrastructure, awareness and accessibility add barriers to reducing TB. To combat these poor environmental factors the Indian government has developed a myriad of programs to improve TB outcomes. 

Panchayat Initiative

The goal of the Panchayat (a village council) Initiative is to tackle TB on a small-scale village level. By working with local governments the initiative has elevated TB awareness, care and prevention in more than 500,000 villages. This was accomplished by creating TB units that covered five villages each and had members inform residents about TB identification, early diagnosis and treatment. 

Ni-Akshay Mitra Campaign 

The Ni-Akshay Mitra campaign focuses on reducing the stigma surrounding TB in India. By creating a public government program easily accessible via the internet citizens are able to access vital information. The program offers an array of support ranging from dietary, diagnostic and occupational information. The campaign has already reached over 1 million TB patients and has had success in building a culture aiding the elimination of TB in India. It also highlights nutritional information that recent studies have shown can be instrumental in preventing and reducing TB. 

Government Aid 

A primary barrier to TB treatment in India is a lack of monetary resources. TB treatment can total about $700 in direct and indirect costs, but the average monthly salary in India is $387. To curb this, India’s Direct Benefit Transfer a government program provides money to TB patients. The program has helped about 8 million patients and distributed $260 million. 

The government has also focused on helping citizens with care. Recently developing a family-focused model of care through the Ministry of Health to aid family caregivers in treating TB. Information made easily accessible by the government teaches caregivers through media, videos and animations. 

Looking Forward 

While there are still barriers and challenges regarding TB that need addressing, such as increasing drug resistance and hindered infrastructure due to the COVID-19 epidemic, India is no doubt ahead of the WHO’s schedule in eliminating TB. Reducing TB is another weight that is lifted off those suffering from poverty and is a great step in working to improve the lives of billions living in India.

– Aditya Arora
Photo: Flickr

tuberculosis in MoldovaTuberculosis, a bacterial lung infection transmitted through coughing and sneezing, ranks as one of the most widespread global diseases, with only COVID-19 surpassing it in death toll. In 2021, TB diagnoses worldwide reached 10.6 million, and Moldova alone accounted for 3,000 cases.

On the bright side, the Stop TB Partnership is diligently working to prevent this treatable yet often fatal disease from gaining a stronghold. The organization’s efforts span the globe, aiming to halt avoidable deaths among those who may not otherwise receive adequate health care.

Combating Tuberculosis in Moldova

  1. Testing Accessibility for the Community – One aspect of disease prevention that the Stop TB Partnership takes very seriously is the testing process, as many may be left undiagnosed, or even misdiagnosed by doctors. Not only this, but many who live in more remote locations do not have sufficient access to testing overall. Notably, Moldova faces a high prevalence of drug-resistant tuberculosis, with 60% of treated cases being this strain. To address these challenges, the Stop TB Partnership collaborates with Moldova’s National Tuberculosis Program to enhance the availability of XPert testing machines in the community. By distributing 30 XPert machines to community health centers, testing facilities catering to TB and prisons, an estimated 64% of Moldova’s population gains easy access to testing. This initiative marks a groundbreaking step, with Moldova becoming the first country worldwide to implement this technology in community centers. Consequently, 1,374 additional TB cases were detected in the first two years of operation.
  2. Raising Community Awareness – While the Stop TB Partnership’s current efforts primarily focus on testing, it has previously undertaken projects that focused on enhancing local communities’ understanding of tuberculosis. To combat tuberculosis in Moldova effectively, there is a need for community members to recognize the disease’s symptoms and respond appropriately when a loved one is affected. In 2009, the Stop TB Partnership partnered with Speranta Terrei, a Moldovan nonprofit, to promote awareness among young children through comic strips. These child-friendly comics, illustrated by Stop TB Ambassador Luis Figo, portray heroes battling TB, effectively disseminating messages about disease prevention and treatment to children in an accessible and enjoyable manner. By distributing these comics to four major Moldovan cities, public comprehension of the disease improves, increasing the likelihood of people seeking testing.
  3. Using AI to Fight TB – In recent years, AI has become increasingly utilized for diagnosing, treating and proposing novel cures for communicable diseases, including TB. As part of its commitment, the Stop TB Partnership introduced AI4HLTH, an initiative that aims to enhance TB diagnosis efficiency through AI technology. The AI effectively assesses chest X-Rays of patients, identifying abnormalities consistent with tuberculosis infection. By employing this crucial tool, doctors are relieved of the burden of manually assessing every X-Ray, allowing them to focus more on treatment after a successful diagnosis. Furthermore, this approach reduces the number of undiagnosed cases due to limited health care staff availability.

Looking Ahead

In the battle against tuberculosis, the Stop TB Partnership is making significant strides with innovative and community-focused initiatives. By increasing testing accessibility through XPert machines and raising awareness through child-friendly comics, the organization is empowering Moldova’s communities to combat the disease. Additionally, the use of AI technology in TB diagnosis streamlines the process and enables health care professionals to focus on providing timely treatment. These efforts offer hope for a future of reduced TB impact in developing countries like Moldova.

– Annabel Kartal-Allen
Photo: Unsplash

On June 28, the Bill and Melinda Gates Foundation announced that they would contribute $400 million to the late-stage trial for a new Tuberculosis vaccine. The M72 vaccine, if approved, will be the first new TB vaccine in 100 years. According to the WHO, 1.6 million people died from TB in 2021 and 80% of cases and deaths were in developing countries. Therefore, this vaccine could have an enormous impact on the developing world and people in poverty.

How it Works

The M72 vaccine is a subunit vaccine, meaning that it contains two antigens that are found on the surface of TB bacteria. These antigens, when recognized by the body, provoke an immune response to the TB bacteria. The antigens were specifically selected by the vaccine developer, GSK, for having such a solid ability to provoke this immune response against TB. In 2019, early trials of the M72 TB vaccine showed it to be 54% effective in adults with latent TB, a group that no vaccine has worked on before.

Latent TB refers to the period after initial infection with the TB bacteria but before the active TB stage begins. When initial infection occurs, the body mounts an immune response, but some bacteria survive this. During the latent stage, these surviving bacteria multiply, and patients usually do not experience any symptoms. This stage can last months or years until the immune system can no longer control the bacteria, at which point the active stage of TB begins.

The only existing TB vaccine, the BCG vaccine, is made from a weakened strain of TB. While it is effective at combating meningitis and TB in children, it does not prevent primary infection or the reactivation of TB bacteria after the latent stage. Therefore, unlike the M72, it is not effective in adults with latent TB.

Funding the Trial

Despite this vaccine being the first to affect people with latent TB, GSK decided that it was not financially viable to pursue further trials because of the 54% efficacy. However, two charities have stepped in to keep the vaccine alive.

The stage three trial that the Bill and Melinda Gates Foundation is making a contribution toward will cost $550 million. The Foundation’s $400 million donation, its largest-ever investment in a single project, will be combined with a further $150 million from the Wellcome Trust to make up this total. The trial will take place at a dozen locations across Africa and Asia, selected for their unusually high rates of latent TB infection so that scientists can efficiently determine if the vaccine prevents active TB from beginning. The trial will involve around 26,000 participants and will take four to six years to complete.

However, the investment from charities alone may not be enough. The vaccine could still need a commercial partner, something that the Foundation hopes to secure in the next 12 months. There is concern about this, since the lack of a market for the vaccine in the developed world may discourage many vaccine makers. However, Indian vaccine producers have expressed interest, since the jab would significantly impact their country, where it’s estimated 504,000 people died from TB in 2021.

The Bottom Line

According to the WHO, if the trial proves that the new TB vaccine really does have a 50% efficacy rate, it could save up to 8.5 million lives by 2050, with the most significant impact being in developing countries and for people living in poverty. Additionally, it could prevent the prescription of 42 million courses of antibiotic treatment, and therefore hopefully combat TB’s antibiotic resistance.

With the potential to be the first new vaccine in 100 years, the M72 jab is promising. However, the fight against TB is not yet over. Despite the lack of burden in wealthier countries, this vaccine still needs attention in the developed world, particularly from vaccine producers, so that, if it proves viable, it can help people in poverty around the world.

– Lily Cooper

Photo: Flickr

TB Elimination AllianceLaunched in 2019, the TB Elimination Alliance (TEA) is an organization ending tuberculosis in underrepresented Asian American and Native Hawaiian/Pacific Islander populations. Currently, 13 million people have latent tuberculosis infection (CDC, 2023). Of this number, 36% of Asian/Asian Americans and 25% of Native Hawaiians and Pacific Islanders have tuberculosis. To help combat the high rates of tuberculosis in these communities, the TB Elimination Alliance has four goals: outreach, awareness, resource sharing and partnership development.

Outreach

TEA’s primary goal is to reach “underserved AA and NH/PI communities with the highest TB burden.” One way the organization achieves its goal is by contacting community health centers. For instance, in 2022, TEA invited the health centers to complete surveys that collect data on the needs of the Asian and Native Hawaiian/Pacific Islander community, specifically regarding tuberculosis, so that the organization could know how to help them best.

Awareness

The second goal of TEA is to raise awareness about tuberculosis treatment and testing. One way TEA does this is by providing a summary of the U.S. recommendations for testing and treatment on its website for people who need access to that information. The organization also creates webinars for health care workers and companies that “discuss successful strategies for screening, testing and treatment in high-need populations in community health care settings.” The webinars aim to raise awareness in the health care community of the issues facing high-risk populations regarding tuberculosis.

The Tuberculosis Elimination Alliance and Hep B United also hold an annual TB Summit with “workshops, panels, networking” with the goal of “celebrating the achievements and progress towards hepatitis B and tuberculosis elimination”. The publicity surrounding this event also brings awareness about tuberculosis to Asian and Native Hawaiian/Pacific Islanders communities.

Sharing Resources

The third goal of the Tuberculosis Elimination Alliance is to share resources and information with communities at high risk for tuberculosis. One resource the organization shares is a self-study module about tuberculosis on its website.

Additionally, the organization also hosted a webinar titled “Quality Improvement Strategies for Latent Tuberculosis Infection (LTBI) Testing and Treatment in Asian American- (AA-), Native Hawaiian (NH-), and Pacific Islander- (PI-) Serving Health Centers: Standardized Data Collection Opportunities” so that the health care companies and workers were not only informed on the issues facing high-risk communities but knew how to respond to these issues as well.

Developing Partnerships

The fourth goal of the Tuberculosis Elimination Alliance is to develop partnerships with other organizations to “scale existing initiatives.” It partners with STOP TB USA, which aims to “ strengthen the ability to search for, treat and prevent TB.”

Another partner of the Tuberculosis Elimination Alliance is the Asian and Pacific Islander American Health Forum. This organization works to “influence policy, mobilizes communities, and strengthens programs and organizations to improve the health of Asian Americans & Native Hawaiians/Pacific Islanders.” 

The Tuberculosis Elimination Alliance finally partners with local clinics like Hope Clinic, which provides health care in “over 30 languages.”

Influence

Through outreach, awareness, sharing resources and developing partnerships, the Tuberculosis Elimination Alliance has helped many people. Since the organization began in 2019, $573,500 in mini-grants have been awarded in 17 states to help with tuberculosis efforts in Native Hawaiian/Pacific Islander, African American, Latinx and Asian American communities.

Additionally, within the last 15 years, 36 million people have been cured of tuberculosis. One of the big reasons for this is because of organizations like the Tuberculosis Elimination Alliance, which reaches out to underrepresented communities like the Asian American and Native Hawaiian/Pacific Islander communities so that they get the help they need.

– Hope Yonehara
Photo: Flickr