World Tuberculosis Day: Easing the Continuum of Care Burden

March 24 marks the annual World Tuberculosis Day and remains an important reminder of the significance of this disease. It commemorates the day in 1882 when German physician and microbiologist Robert Koch surprised the world by telling a group of scientists at the University of Berlin's Institute of Hygiene that he had discovered the cause of tuberculosis, the TB bacillus.

Since that time, great strides have been made in understanding the bacterium and curative treatment has been developed. However, a marked difference in the continuum of care remains between what is experienced in low-and-middle-income countries (LMIC) and what is experienced in the United States. Starting with the statistics, there is a huge discrepancy in what is being seen in terms of cases and the number of deaths. (Table)

Table

1. Latest CDC statistic for 2022
2. CDC statistic for 2019
3. World Health Organization statistics for 2021

The continuum of care is different, and in the US and other developed countries, patients have the ability to see their providers on a regular basis and see treatment all the way through—this is not always the case in LMIC.

“In the US and Europe, we have managed to get TB somewhat under control,” said Michael W. Dunne MD, FIDSA chief medical officer, head of development, Bill & Melinda Gates Medical Research Institute. “The burden of TB in the developed world has significantly reduced over time because we have good preventive measures, good treatment regimens, that can be monitored here. And that is the important point…it is more difficult to do that in the rest of the world.”

Dunne points out this is the crux of the issue and the ability to care for patients continuously over the many months it takes to cure a patient with TB. “How do we make it easier for low-and-middle-income countries to be able to get a handle on TB?”

Within the US, not only has there been a great emphasis on TB care, the type of TB being seen here is different. More than 80% of TB cases in the US are associated with latent TB infections (LTBI) says the CDC. With LTBI, patients are treated with shorter medication regimens that are 3-4 months as opposed to someone who has active TB and needs to be on medications for 6 months. Innovation is another factor that differs in the US. For example, the CDC-recommended video-directly observed therapy (vDOT) can conserve time and costs for some patients and TB programs.

The Bill & Melinda Gates Medical Research Institute has a special focus on health care issues in LMIC. The institute is a non-profit organization dedicated to the development and effective use of novel biomedical interventions addressing substantial global health concerns, for which investment incentives are limited. The institute works through collaborating partners and organizations, coordinating and driving the full spectrum of biopharmaceutical development activities, including pre-clinical development, full clinical development (from phase 1 through to and including phase 3), and global regulatory interactions.

As part of its strong commitment to TB, the institute has 6 therapies and 1 vaccine in development. The therapies and vaccines are still in the early stages, but have shown promise says Dunne.

Dunne explains the institute, along with its partners, are trying to develop new antimicrobials to eliminate susceptibility testing and multidrug resistance. They also want to decrease the amount of time patients are on the therapy so they will more likely adhere to their regimen.

Contagion spoke to Dunne who offered insights about the challenges of LMIC and TB treatment, and information on the institute’s vaccine and investigational therapies.