New Medicine Can Solve the Tuberculosis Crisis in Mexico
Tuberculosis (TB) is an infectious bacterial disease that most commonly affects the lungs. It transfers from person to person by cough-induced airborne droplets. For healthy people, the infection is typically fought off by the body’s immune system and symptoms are rare. However, when symptoms are active, a person with TB experiences coughing, sometimes with mucous or blood, chest pains, weakness, weight loss and fevers.

Thankfully, TB is a treatable disease if the patient has access to the requisite six-month course of antibiotics. Patients who cannot complete the full treatment cycle have not fully eliminated the bacteria from their bodies. Often times, patients in poorer nations simply do not have access to extensive treatment or cannot afford it, and can become sick again with a more virulent, resistant form of the disease that is less responsive to treatments – also known as drug-resistant tuberculosis (DR-TB). Currently, about one-third of the world’s population is infected with a latent form of TB. Each year, nearly two million die as a result of one of the world’s deadliest diseases.

In the last few years, new drugs have been developed to aid in the fight against the strains of DR-TB. Between 2012 and 2014, bedaquiline and delamanid were the first drugs developed to treat TB in over 50 years. They represent a lifeline for the people who are suffering from the most resistant forms of TB. However, people around the world are not receiving access to the drugs. The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) is aiming to change that, starting in Guadalajara, Mexico, where the global TB community is meeting for the 48th Union World Conference on Lung Health later this year. Some physicians are hopeful that new medicine can solve the tuberculosis crisis in Mexico.

Prior to 2010, Mexico had been experiencing a consistent decline in the presence of the disease. Between 1990 and 2010, the studies with the National Institutes of Health estimate that rates were decreasing annually by about two percent. However, thousands are still diagnosed in Mexico every year. The spread of the disease does not end at its borders, either. The U.S. reports that over 20 percent of its foreign-born TB cases are Mexican, making the presence of TB continue to be a public concern for Mexico and its neighboring countries.

The World Health Organization (WHO) estimates that globally, nearly 30 percent of patients with DR-TB could benefit from the introduction of the new drugs into the medical regimen. Yet, as of July 2017, less than 11,000 people are taking new medications. According to Doctors Without Borders, the TB treatment community is largely concerned with the low uptake of the new drugs that have a high potential to aid those with the lowest chances of success under the current standard. Prior to the new drug developments, DR-TB patients are prescribed to take over 15,000 pills over the course of two years. Dr. Isaac Chikwanha, HIV and TB Medical Advisor at MSF’s Access Campaign say, “Today, it’s unacceptable to continue treating [patients] with the same old regimen of medicines and not providing better treatment, knowing very well that we could be giving people a much better chance to stay alive by using these newer drugs.”

Fortunately, despite the conservative physicians’ resistance, the new drugs are being expedited and have since been distributed in over 14 countries. Advocates and campaigns continue to place the spotlight on better TB treatment options being available but underutilized. Poor nations in particular need to focus on acquiring these new drugs, as the sick and malnourished are often even more susceptible to TB than others.

While the Center for Disease Control has identified a TB epidemic throughout the country, new medicine can help solve the TB crisis in Mexico with the implementation of new treatment regimens. Local communities, in conjunction with research and medical services, must cooperate to continue advancing medical treatments. Only then can the global community finally fight back against TB.

Taylor Elkins

Photo: Flickr

Tuberculosis InfectionEvery year, 30,000 individuals in Papua New Guinea are newly infected with tuberculosis. Tuberculosis is an airborne infection that causes the bacteria mycobacterium tuberculosis to develop into a disease that destroys organ tissue most commonly in the lungs. It can be fatal if left untreated. From those 30,000, one out of four are diagnosed; one out of five receive treatment; and less than half get successfully treated. If left untreated, one person can infect 10 to 15 people every year.

Increasing incidences due to minimal health care, poor housing and nutrition have contributed to poverty, overcrowding and people failing to complete their treatment. In fact only 50 percent of individuals have access to adequate healthcare. Children face the greatest risk of contracting disabling forms of tuberculosis. Unfortunately, 10 percent of children die from tuberculosis.

Papua New Guinea’s island of Daru has the highest rate of tuberculosis infection in the world. Out of 150,000 people on the island, 160 get infected with drug-resistant tuberculosis as of January 2016. The rise of two aggressive strains of tuberculosis are a result of recent developments of antibiotic resistance.

This resistance stems from multidrug resistant and extensively drug resistant tuberculosis. To treat tuberculosis infection, a daily regimen of injections, oral medication and supervised medical care of anywhere between six to 24 months is recommended.

With funding from the United States Agency for International Development and the National Department of Health, FHI360 is hosting a series training courses for doctors to introduce Bedaquiline. Janssen Pharmaceuticals developed Bedaquiline, the first new class of antibiotics approved by the United States Food and Drug Association in more than 40 years.

By utilizing pharmacovigilance—the science of early detection and adverse effects—Bedaquiline is slowly being introduced to practitioners and their patients. In fact, 85 courses of Bedaquiline have already been distributed to Daru hospital.

Tiffany Santos
Photo: Flickr

Ghana plans to end tuberculosis (TB) and other lung-related diseases by 2030 through the aid of diagnostic technology GeneXpert, according to Ghanaian doctor Frank Bonsu. He spoke at a press conference before the opening of the 20th Conference of the Union Africa Region on Lung Health. The four-day-long conference, held approximately every two years, brings together more than 800 international and African delegates to discuss and plan tactics for eliminating TB and other lung diseases from the African continent.

Bonsu is the chairman of the conference as well as the program manager of Ghana’s National TB Control Programme. He said that although Ghana has made strides in fighting TB, there are still many cases that go undetected. Ideally, 44,000 cases of TB should be detected each year, but currently, only 15,000 are diagnosed. Bonsu blames the country’s lack of modern diagnostic equipment, its low number of microbiologists, the population’s poor awareness and the stigma of the disease that keeps people from seeking medical aid.

A combination of Ghana using GeneXpert and a reduction of the negative stigma against TB, Bonsu believes, is needed for effective eradication. The National TB Control Programme also changed its emphasis from treating those who seek medical attention at facilities to its current outreach strategy in risk communities. The program hopes going out and offering aid will encourage early diagnosis, increase treatment and decrease stigma.

GeneXpert is a molecular test that can detect even the smallest amount of TB bacteria. It can also test for resistance to the common TB antibiotic Rifampicin. The main difference between GeneXpert and the other methods of TB detection, such as sputum microscopy, is its reliability and speed. GeneXpert can have results in less than two hours as opposed to weeks.

GeneXpert can only be used for diagnostic purposes and cannot be used to properly monitor treatment. It also does not eliminate the need for conventional microscopy culture and drug sensitivity testing, according to the World Health Organization, as these tactics are still needed to monitor treatment progress and detect other types of drug resistance. Yet GeneXpert is a major milestone in TB diagnostic technology.

With Ghana using GeneXpert, many more cases of TB can be caught early and treated more effectively. Ghana hopes that with the introduction of this new technology by the end of this year, along with outreach programs and a decrease in negative stigma, the country will be free of TB in 2030.

Hannah Kaiser

Photo: Flickr

The threat of XDR-TB has recently caused great concern. This disease has been reported in 117 countries and is the deadliest strain of tuberculosis (TB). It is highly drug-resistant and is immune to many antibiotics. It is resistant to four standard treatments for tuberculosis. Because of this, treatment options for XDR-TB are less effective, more expensive and have more adverse side effects. The medication used to treat the disease is taken for up to two years and can cause permanent deafness, nerve damage, vomiting and rashes. The disease itself affects the lungs, causes chest pain and the coughing of blood.

The threat of XDR-TB transmission is the highest among individuals infected with HIV. In 2006, 52 out of 53 patients with both HIV and XDR-TB were reported to have died, and most died soon after the diagnosis. Treatment is successful less than 40 percent of the time, and death rates are as high 80 percent.

Cases of XDR-TB have rapidly intensified in South Africa, and it was found to have extensively spread in KwaZulu-Natal. It has caused tremendous concern among authorities. Between 2002 and 2015, there was a tenfold increase in the disease’s prevalence in South Africa. The threat of XDR-TB has become a challenge for many hospitals and community settings, households and workplaces.

This disease spreads similarly to other forms of tuberculosis. When a person with TB sneezes, coughs, shouts or sings, bacteria to float in the air, which can spread the disease. It has also been diagnosed in persons who were previously taking medication for TB, and the anti-TB drugs were misused or mismanaged. However, nearly 70 percent cases are spread from person to person. In a study of 404 patients with XDR-TB, an analysis showed that 69 percent of the cases were transmitted from person to person.

Efforts need to be directed towards identifying and implementing new interventions to prevent the transmission of XDR-TB in hospitals and community settings. Separation of people with suspected TB from other patients, more rapid diagnosis, and more effective medication is required for the disease. National governments need to plan interventions to prevent the threat of XDR-TB from spreading and to ensure supplies of medication are more readily available.

Aishwarya Bansal

Photo: Flickr

 Tuberculosis Regimens
Tuberculosis (TB) is one of the top ten causes of death worldwide and disproportionately affects the developing world. Though the number of TB deaths decreased from 2000 to 2015, it is responsible for more deaths than HIV and malaria combined. Over the past several years, multi-drug resistant tuberculosis (MDR-TB) has steadily risen. Approximately half a million cases of MDR-TB were reported in 2015. Resistance often develops secondary to patient non-compliance.

Given the complexity and duration of tuberculosis therapy, it is no surprise that many patients struggle to take the medications as directed. Initial first-line therapy consists of isoniazid, rifampin, pyrazinamide and ethambutol. The four-drug regimen must be taken at least five times a week for eight weeks during the initial phase. Then, the patient must continue taking two medications for an additional 18 weeks.

Treatment failure can require eight months of retreatment. If drug resistance develops, treatment can take two years and has a high rate of failure.

Researchers at the University of California at Los Angeles have been working to develop new tuberculosis regimens that could boost the probability of treatment success. Using Parabolic Response Surface (PRS) technology, the team identified drug combinations with higher antimicrobial activity than the Standard Regimen of isoniazid, rifampin, pyrazinamide and ethambutol.

PRS Regimen I includes clofazimine, ethambutol, prothionamide and pyrazinamide. For PRS Regimen II, bedaquiline is used instead of prothionamide.

So far, the new tuberculosis regimens have only been tested on mice, but the results are promising. Differences in efficacy, quantified by the number of colony-forming units, were statistically significant for both PRS regimen groups compared to the Standard Regimen control group.

For both of the new tuberculosis regimens, efficacy was dependent on the pyrazinamide dose. The bedaquiline dose also affected the efficacy of PRS Regimen II.

PRS Regimen I took 12 weeks to achieve 100% relapse-free cure while variations of PRS Regimen II achieved cure in three to four weeks. The Standard Regimen takes 16 weeks to achieve a relapse-free cure. Based on these results, a new tuberculosis regimens could reduce treatment duration by as much as 75%. Such a drastic reduction in length of therapy could facilitate better patient compliance.

The next step is to see whether or not the results in mice can be replicated in human beings. Given the rise of drug-resistant TB, successful treatment of human subjects with these new tuberculosis regimens would be a huge victory for global health.

Rebecca Yu

Photo: Flickr

Treatments for TuberculosisTuberculosis is the leading infectious cause of death worldwide. However, the full extent of childhood tuberculosis is poorly understood. According to 2015 World Health Organization estimates, TB infected more than one million children and killed more than 200,000. Given the difficulty of diagnosis in children, the true burden of this disease is likely even greater than reported.

Tuberculosis most commonly affects the lungs and is spread by infected airborne particles, released by patients with the active disease. Because transmission is augmented in overcrowded, poorly ventilated areas, people living in poverty are disproportionately affected. More than 95 percent of TB-related deaths occur in low and middle-income countries.

Active tuberculosis is often asymptomatic or causes vague symptoms such as general malaise, anorexia, and weight loss. A cough is the most common symptom and often becomes progressively productive. Diagnosis is based on the results of sputum samples.

Treatment regimens consist of multiple medications taken for extended periods of time. To ensure adequate therapy, patients must take a certain number of doses. If too many doses are missed, treatment must be restarted. Problems with patient non-adherence have led to the rise of directly-observed therapy (DOT) in which a public health worker witnesses the patient’s medication consumption.

In addition to the extensiveness of the drug regimen, the bitter taste of the medications can be a significant barrier to adherence, especially for children. TB Alliance has already helped to develop liquid formulations for first-line antituberculosis drugs, but with the rise of drug-resistance, alternative therapies must also be made more kid-friendly. PepsiCo has stepped up to partner with TB Alliance in developing tastier treatments for tuberculosis.

As a highly successful beverage company, heavily invested in research and development, PepsiCo is a logical collaborator in this endeavor to develop tastier treatments for tuberculosis. Since 2011, PepsiCo has increased investment in research and development by 35 percent. The emphasis on innovation has undoubtedly contributed to the company’s success. In addition, as a global brand, PepsiCo garners insights from countries most heavily affected by tuberculosis. The company has R&D facilities in India and China, two of the six countries that account for more than 60 percent of tuberculosis cases.

Rebecca Yu

Photo: Flickr

How the World Bank is Eradicating Tuberculosis in Southern Africa
Earlier this year, the World Bank Board approved financial aid of $122 million for eradicating tuberculosis (TB) in Southern Africa’s four most TB-ravaged countries: Lesotho, Malawi, Mozambique and Zambia.

Tuberculosis continues to stand as one of the world’s deadliest diseases—and one of the most preventable and curable. Last year alone, initiatives for eradicating tuberculosis in Southern Africa saved more than three million lives. While this certainly demands celebration, statistics revealed simultaneously that 10.4 million people still became infected, with another 1.8 million dying from it.

Dr. Margaret Chan, Director-General of the World Health Organization said late last year, “We face an uphill battle to reach global targets for tuberculosis. There must be a massive scale-up for efforts, or countries will continue to run behind this deadly epidemic and these ambitious goals will be missed.”

The World Bank has risen to this call.

Since its establishment in 1960, the World Bank’s International Development Association has provided financial assistance programs and policies that improve lives in the world’s poorest nations. Over the last three years, it has given roughly $19 billion. Fifty percent of this has gone to Africa.

The World Bank’s recent assistance in eradicating tuberculosis in Southern Africa will go towards the Southern Africa Tuberculosis and Health System Support Project, which largely benefit the four previously specified countries. Lesotho, Malawi, Mozambique and Zambia carry a high burden of tuberculosis. This is widely due to growth in their mining communities, an increase in resistance to drugs that already fight TB and their intraregional economic activity with each other. Because TB is communicable, its spread is often aggravated by the close quarters and harsh conditions that mining workers are required to work in. As the workers travel home, and often across borders, civilians unrelated to these environments become susceptible to its infection.

As the World Bank gives a great boost to the System Support Project, the leaders of this initiative will be able to seek out more effective means of detection, prevention and treatment of TB. Funds will also support regional learning on this issue and surveillance of TB’s travel patterns, which will reinforce the innovation of preventive strategies.

Should other organizations and institutions follow in the World Bank’s wake, the World Health Organization’s vision to see tuberculosis nearly ended by 2030 may very well become a reality.

Brenna Yowell

Photo: Flickr

Eight Facts about Tuberculosis
Tuberculosis (TB) is a widespread bacterial disease that has been around for much of recorded human history. The following are some key facts about TB to learn more about what is going on with the disease.

  1. Symptoms of TB include persistent coughing, chest pain, fever, fatigue and chills. TB most often infects the lungs. It is a contagious disease and is transported through the air.
  2. In 2014, there were 9.6 million cases of TB and 1.5 million deaths as a result. According to these findings, TB was the most deadly infectious disease in the world that year.
  3. Ninety-five percent of deaths caused by TB occur in low- and middle-income countries. Not only does TB disproportionately affect people in these countries, but also people living in developed countries are often unaware of the prevalence and danger of TB.
  4. TB is particularly dangerous to those who are HIV positive. Those with HIV are 26 to 31 times more likely to develop TB than those without HIV. One-third of HIV-related deaths in 2015 were a result of a TB infection.
  5. Latent TB actually infects about one-third of the world’s population. In its latent form, the TB bacteria are not active, meaning they do not cause symptoms and are not contagious. However, those with latent TB have a 10 percent chance of contracting active TB in their lifetime.
  6. TB is a treatable disease. Typically, a properly prescribed program of antibiotics can cure the disease. However, multidrug-resistant TB, which arises due to improper treatment can pose an obstacle. When a treatment of antibiotics fails to eradicate all the bacteria, drug resistant strains can develop.
  7. Much progress has been made against TB. From 2000 to 2015, the incidence rate of TB dropped by 18 percent, and from 1990 to 2015, the death rate dropped by 47 percent. Another way to look at TB reduction is to realize that from 2000 to 2014, 43 million lives were saved as a result of efforts to combat TB.
  8. An anti-TB drug specifically for children’s use was developed early this year. In the past, children had to use adult medication, which meant manually cutting down the dosage to meet the children’s needs. The new child-specific drug comes in appropriate doses, is dissolvable in water for ease of consumption, and even tastes better.

These facts illustrate how dangerous TB is and also the progress that is being made against it as well. With additional developments, the world can hope that the U.N.’s sustainable development goal of ending the TB epidemic by 2030 will become a reality.

Edmond Kim

Photo: Flickr

What's Being Done About Global TB RatesThe World Health Organization (WHO) recently released their annual report on the state of tuberculosis (TB) epidemic and efforts aimed at curtailing the disease globally. The report found that global TB rates have again declined by an average of 1.5 percent but estimates of incidence were grossly undershot in places like India, China and Russia.

In addition to the already grim picture, the WHO report concedes that notification and diagnostic systems continue to lack in high-risk areas. These newly exposed realities severely muddy the larger picture of successes and shortcomings. And they are surely expected to result in a reported stagnation of global TB rates for years to come, despite the 2030 U.N. Sustainable Development Goals (SDGs) explicit mention of curtailing TB as an epidemic.

Complicating efforts to combat the problem and to plan future long-term strategies is the reality that TB is increasingly experiencing multi-drug resistant strains of the disease. In fact, such cases account for over 40 percent of estimated global TB cases.

In recent months, much greater efforts have been spurred to collectively address the global TB crisis. Caucuses have been organized in Latin America, Eurasia and Africa, and several Asian and African nations have passed legislation aimed at ending TB rates in their respective countries in accordance with U.N. and WHO goals and aspirations.

In March, the Americas TB Caucus was formed and included in its ranks Brazil, Bolivia, Nicaragua, Peru and Uruguay. In June, 13 nations stretching from the United Kingdom to Kyrgyzstan announced the formation of the Eurasian Parliamentary Group on TB. And in July, the African TB Caucus was launched and included 18 nations from across the continent, particularly the hard-hit South Africa.

The Philippines, Sudan and Zimbabwe have also announced national efforts this year aimed at combating TB.

In addition to funding efforts to disseminate prevention and treatment methods to those affected, parliamentarians and researchers alike also see a need to treat the social symptoms of TB so as to eliminate factors and settings that can lead to a widening of the epidemic such as endemic poverty rates in high-risk areas.

The WHO included in its 2016 report on social implications for the fight against global TB rates that: “Ending TB and ending poverty are intertwined goals. Ministries of health, affected communities and partners can do more to use available evidence of the links in order to advocate for poverty elimination and action on related risk factors (e.g. noncommunicable disease prevention, food security, and housing).”

James Collins

Photo: Flickr

USAID Defeat Tuberculosis in the Kyrgyz Republic
Hakmiddin lives in a small village in northern Kyrgyzstan. After being diagnosed with tuberculosis several years ago, he never completed a full course of treatment because he had to return to work. As a result, he did not receive the necessary medications. There are many people who share Hakmiddin’s struggle against tuberculosis in the Kyrgyz Republic today.

Kyrgyzstan has one of the highest rates of tuberculosis in Europe. According to the latest data, multidrug-resistant tuberculosis (MDR-TB) is now at 26 percent among new cases, compared to three percent of new tuberculosis cases worldwide. Drug supplies were limited and universal treatment standards were lacking in the country. According to the World Health Organization, only 55 percent of MDR-TB cases were successfully treated in 2011.

In response to this pressing challenge, USAID partnered with the Kyrgyz Republic to manage this deadly disease through improved services, diagnostics, new clinical guidelines, new outpatient treatment and care models. In 2012, led by the KNCV Tuberculosis Foundation, Kyrgyzstan’s National Tuberculosis Program and the Ministry of Health developed new national guidelines on MDR-TB, in collaboration with the USAID-funded TB CARE I project.

The project worked with community groups and non-government organizations to ensure more equitable access to tuberculosis in the Kyrgyz Republic in addition to diagnosis, treatment and a reduction in the social stigma attached to the disease. It also provided training for health care workers and reformed health financing systems to improve tuberculosis treatment in the country.

As a result, patients are able to receive the care they need based on the type of tuberculosis they have, including full outpatient treatment. These efforts resulted in increasing the MDR-TB treatment success rate from 42 percent in 2011 to 57 percent in 2013. In 2014, USAID followed up its previous efforts and developed a five-year project, the USAID Defeat Tuberculosis project, to ease the burden of tuberculosis in the Kyrgyz Republic and strengthen its health care system.

The project offered support for quality improvement and standardization of laboratory services. To jumpstart this process, the USAID Quality Health Care Project introduced a Quality Management System in laboratory networks in Kyrgyzstan. Seventeen lab quality control specialists in Bishkek and Chui Oblast participated in relevant training sessions. Undergraduate and continuing education institutions also integrated some tuberculosis training modules with the project’s support.

Today, 30.6 percent of the population still lives below the national poverty line and 42.7 percent of the employable population is unemployed. Therefore, providing affordable tuberculosis diagnosis and treatment for patients and reducing prolonged hospitalization to ensure people’s productivity are still challenging tasks that the country needs to address in the future.

With two more years left, the USAID Defeat Tuberculosis Project will focus more on advocating childhood and adolescent tuberculosis diagnosis and treatment, as well as the prescription of child-friendly drug formulas in the country.

Yvie Yao

Photo: Flickr