Latest news with #tuberculosis
ABC News
2 days ago
- Health
- ABC News
Queensland research finds inhaled vaccine effective tuberculosis protection
A research team from north Queensland has found delivering the tuberculosis (TB) vaccine directly to the lungs could create stronger protection against the world's deadliest infectious disease. There is one available vaccine to protect against TB, developed in 1921, with little known about why the vaccine sometimes stops offering protection in adolescence. World Health Organisation data revealed 10.8 million new TB infections globally in 2023 and 1.3 million deaths. The team from James Cook University found that administering a stronger strain of the only existing Bacille Calmette-Guérin vaccine, or BCG, generated an effective immune response in the lungs. "This link between how the body repairs the lung after minor injury and how that can lead to better protection against tuberculosis is really what this study is about," associate professor Andreas Kupz, who led the study, said. TB is primarily spread through the air when a person with active tuberculosis disease coughs, sneezes or speaks. Dr Kupz said high global rates of TB were in part due to the limited efficacy of the only licensed vaccine, developed to protect adults in 1921 via a shot to the arm. "Because it is delivered as an injection after birth, it often doesn't produce long-term protection against respiratory infections," he said. Dr Kupz said the team's research could hold several important implications for the development of a more effective TB vaccine, eventually saving lives. TB has largely been eradicated from Australia, but is more common in northern Australia, particularly in Cape York and Torres Strait Islands. The latest available Queensland Health data shows the state treated 189 people for TB infections in 2023. Dr Kupz said Cape York and the Torres Strait Islands were most susceptible because of their proximity to Papua New Guinea, which experiences high rates of infection. "Papua New Guinea is actually a hotspot for tuberculosis globally, not just in terms of the numbers of TB they have, but also drug-resistant strains," he said. Port Moresby-based health advocate Anne Clarke said the 45,000 TB cases recorded in Papua New Guinea in the past year were a significant strain on the health system and economy. "The exposure of the wider community to this infectious disease agent is about 100 per cent in this town," Dr Clarke said. "Everybody is affected." Dr Kupz said he hoped his team's research would eventually lead to more effective protection against infections. "Pending ethical approvals, we hope to see it go to human trial by the end of 2026 or early 2027," he said.
CBC
6 days ago
- Health
- CBC
Fears of budget cuts to Nunavik health board based on 'misunderstanding,' official says
Nunavik's health board says there are no budget cuts to the organization, and the financial concerns raised by the region's 14 mayors are due to a "misunderstanding." Last month, the mayors called on the provincial government to declare tuberculosis a public health emergency. They also alleged there were budget cuts to the health board and demanded for them to be reversed. There are "optimization measures" across Quebec's health care network as the province tries to eliminate a $1.5 billion deficit, but Quebec's health ministry said that doesn't apply to Nunavik, and funding for the region's health board is actually being indexed up. The Nunavik Regional Board of Health and Social Services (NRBHSS) has also confirmed there are no reductions to its funding from the province. In a statement, a board spokesperson says there was "a clear misinterpretation and miscommunication" of what was reported at a meeting of the Tuberculosis Regional Committee in the spring. During the NRBHSS's annual general meeting, executive director Jennifer Munick-Watkins made a plea to all leaders in the region to improve communication around tuberculosis prevention and elimination. ''It is by joining forces that we, as Nunavimmiut, can work to reduce the progression of tuberculosis and eliminate it in Nunavik,'' she said in Inuktitut. The Kativik Regional Government, which released the open letter last month on behalf of the mayors, did not respond to several requests for comment by deadline. Despite no budget cuts, the health board said the current funding is inadequate and the mayors' letters reinforced the need for more resources. The region is facing a possible third year of record tuberculosis cases, with outbreaks in six of Nunavik's 14 villages. "The absence of specific provincial funding, as well as local budget constraints, severely limit the ability of facilities to act in the field. It is these front-line shortages — staff, equipment and infrastructure — that are holding back the fight against transmission," a spokesperson said. Systemic inequities in Nunavik Jessika Huard, NRBHSS' infectious diseases coordinator, said tuberculosis treatment can be a long process that can leave patients feeling alone and stigmatized. Treatment usually takes about six months, and it's mandatory for patients to take daily medication in front of a health professional. "People often need to be isolated or flown away from their communities either for testing or for isolation for a few days or weeks. They're separated from their family, from the land," she said. "This can be deeply distressing, especially in the context where we already have mistrust towards the health system." She adds that there is a systemic lack of resources for tuberculosis care in Nunavik, including the shortage of staff, X-rays, as well as training opportunities for Nunavimmiut to be able to deliver basic public health interventions. "This limits our ability to build local capacity and goes against the spirit of self-determination and health," Huard said. Sarah Beaulne, executive director of the Inuulitsivik Health Centre in Puvirnituq, lamented the lack of hotels and other facilities for patients to isolate and get tuberculosis care. "We are trying our best to get a hold of them so that they can be utilized … we will have to be supported and funded by the government," she said in Inuktitut. Going to Manitoba for help Earlier this year, NRBHSS said it needed 700 sputum test kits for diagnosing tuberculosis in mucus. But with the recent surge in cases, the health board said it doesn't have enough funding to acquire the necessary amount of test kits. It ended up asking the National Microbiology Laboratory in Manitoba for some of those kits. "The Ministry of Health has a responsibility for ensuring accessibility, quality and continuous care in Quebec, including Nunavik," Huard said. Both Quebec's Ministry of Health and Social Services and Santé Québec said they didn't receive a request for sputum testing kits. Nunavik's health board said there isn't specific provincial funding for tuberculosis care. Santé Québec adds that it "will provide all necessary support" if the situation requires it. No health emergency for now In a June 20 letter to Nunavik's 14 mayors, Luc Boileau and Horacio Arruda, two of Quebec's assistant deputy ministers at the Ministry of Health and Social Services, said the Nunavik health board is developing an action plan to control tuberculosis. Because of that, they are holding off from using emergency powers under the Public Health Act, but they said they will reassess the situation if needed. "If it turns out that some of these obstacles can only be removed by the exceptional powers granted to us by the provisions of the Public Health Act, then you have our assurance that the necessary means will be implemented," they wrote in French.
News24
6 days ago
- Health
- News24
TB's tight grip: Why this curable disease is so hard to treat
TB is a tough and ancient adversary and keeps adapting. It can be cured, but ridding the body of the bug often takes many months and usually requires different medicines. In this special briefing, Spotlight zooms in on what makes the TB bacterium so hard to beat. There are many things we've learned from studying the ancient Egyptians. One especially fascinating discovery was evidence of skeletal deformities in mummies, which serves as silent markers of a tenacious bug still stalking us today: tuberculosis (TB). With about 10.8 million people around the world getting sick with TB in 2023, it remains the leading infectious disease on the planet, according to the World Health Organisation (WHO). Just in South Africa, it claims more than 50 000 lives per year. In this Spotlight special briefing, we take a closer look at the bacterium that causes TB and why, even now in an era where TB is curable, beating it still requires months of treatment with multiple different medicines. Adapted for survival The mystery of TB's staying power starts with the bug itself. As explained by Dr Jennifer Furin, Mycobacterium tuberculosis is well adapted to survive on multiple fronts. Furin is an infectious diseases clinician and medical anthropologist who specialises in TB. Firstly, she explains, there's it's size. TB is spread through the air when someone who has the bacterium in their lungs coughs it up. It's then contained in small amounts of fluid called droplet nuclei. This droplet is precisely the right size to hang in the air, allowing TB to survive for hours and even days. These droplets can then be inhaled by other people and are just the right size to travel to their lungs. 'It is really amazing from an evolutionary point of view and would be absolutely fascinating if it did not lead to such a horrible disease,' says Furin. Secondly, the bacteria itself are well adapted to avoid being killed, sporting a thick, slimy coating called mycolic acid. This coating makes it difficult for drugs or immune system cells to get into the organism to kill it. The bacteria also have some clever ways of getting around the human immune system, which allows it to 'persist in the body for years and years'. Furin says one way it's able to stay in the body for so long is the bacterium's ability to go into a 'metabolically quiet state' when the immune system starts coming after it. In this state, it stops multiplying until the pressure from the immune system quiets down. It is this combination of being able to pass from person to person and lay dormant in the body when challenged by the immune system that enables TB to thrive in humans. How the body fights back Though hard to estimate with great accuracy, it is thought that only in the region of one in 10 people who inhale the TB bacterium and become infected actually fall ill with TB disease. In fact, some people's immune response is so good that even though they've been exposed to TB, there's no evidence it was ever able to establish an infection in the lungs. For everyone else exposed to TB, one of two things happens. Either the body mounts an immune response that contains and may eventually kill the bug, or the bacteria gets past the immune system and causes illness. To make people ill, the bug needs to get past the first line of defence and get a foothold in the lungs. Unfortunately, the antibodies relied on to kill other bacteria or viruses don't work against TB. Instead, Furin explains, special pulmonary macrophages recognise TB as a threat and 'gobbles it inside them'. Macrophages work by 'swallowing' bugs and then neutralising them by 'digesting' them. But the bacterium's thick, slimy mycolic acid layer prevents the macrophages from killing it. The macrophages with the TB inside, along with other essential immune system cells called CD4 and CD8 cells, then signal more macrophages to help out. These cells then work together to build a wall around the bacteria to keep it contained. Furin compares the CD4 and CD8 cells to foremen who oversee the building of a wall called a granuloma, while the macrophages are like the bricks and cement that form the actual structure. This wall around the TB bacteria needs to constantly be maintained by the immune system. If the immune system is weakened, Furin says the walls break down and the bacterium escapes, coming out of its dormant state and starts multiplying again. If this happens, TB could spread beyond the lungs to other parts of the body. If the walls are built right and maintained, eventually the bacterium is starved to death. Yet, this process can take a long time, sometimes years, because of the bacterium's ability to go dormant. 'Double-edged sword' The 'interaction between TB and the immune system is a double-edged sword', says Professor Graeme Meintjes, an infectious diseases specialist with a research interest in HIV and TB at the University of Cape Town. 'The immune system is trying to contain and kill TB. But at the same time, TB is using the immune system to perpetuate infection from one person to the other,' he says. Meintjes explains that TB has evolved alongside people and developed special proteins and molecules that cause the immune system to react to it. It needs this reaction to cause damage in the lungs, leading to it being released during coughing or even breathing, which helps spread it to other people. 'The TB excites the immune response that causes damage [to the lungs] and that allows it to be released into the airway and either coughed or breathed out. So, there's some evidence that TB has evolved to elicit the immune response in order to achieve that,' he says. Adding to this, for some people cured of TB, Furin says that a condition known as post-TB lung disease can, in part, be caused by the granulomas grouping together, which causes cavities to form in the lungs. This can lead to scarring and sometimes surgery is required to remove these areas of destroyed lung tissue. The immune system can also start 'over functioning' if it senses the bacterium has escaped from the granulomas and is spreading. This causes the immune system to send out special chemicals called cytokines that can cause indiscriminate killing of the lung cells around it. She says this is like the immune system going after one target with the intention to kill it but then blowing up the whole neighbourhood. TB works differently in different people The complex interplay between the immune system and TB makes it difficult to predict which individuals will become sick with TB and who won't, although there are some clear trends. Meintjes says factors like malnutrition, poverty, overcrowded living or working conditions and multiple exposures to TB are some of the biggest drivers of infection and disease. Factors like genetics, the amount of TB someone is exposed to, or a person's initial immune response are also thought to play a role. 'But still, in a given setting where you have two people living in a household, one of them might go on to develop TB disease with the same exposure and the other not. And there are factors that are not fully explained about why some people will develop TB and others won't,' he says. Probably the most important risk factor for TB in South Africa over the last three decades has been untreated HIV. Because HIV targets specifically CD4 cells, it's the worst thing that could have happened in a world with TB, Furin says. HIV infiltrates and kills a person's CD4 cells, which means the immune system then has fewer of the cells ready to fight TB. In 2024, more than half (58%) of all adults receiving TB treatment in South Africa were also living with HIV, according to estimates from Thembisa, the leading mathematical model of HIV and TB in the country. READ | IN THE SPOTLIGHT: SA has started a TB revolution – can we see it through? Another group that is at high risk of TB disease is children, particularly those younger than two. The good news is that there is a vaccine that reduces this risk. As Furin explains, the BCG (Bacillus Calmette-Guérin) vaccine works by showing the CD4 and CD8 cells how to build the 'protective wall' against TB, because the immune systems of children are still too 'immature' to know how to do it without help. 'It [the BCG vaccine] only works for a little bit of time, but it works great to protect kids against those very severe forms of disease, while their own immune systems are learning [how to fight TB],' says Furin. Because the vaccine only protects children for a short time, the WHO recommends one dose be given at birth for children in countries with a high TB burden. Despite much research efforts to find another vaccine, and a promising candidate being studied in a Phase 3 trial, BCG remains the only TB vaccine in use for now. A brief history of TB treatment Though TB has been making humans sick for many centuries, the bug that causes the illness was only identified in 1882, by German physician and microbiologist Robert Koch. It would be roughly another 60 years before the first effective treatments would become available. Until the 1940s, TB treatment mainly involved staying in a sanatorium. The first drugs to treat TB with any success were the antibiotics streptomycin and para-aminosalicylic acid. These two drugs had significant side effects and using only two drugs often lead to TB becoming resistant to the treatment. As described in this excellent overview, what followed was a 'great flurry of drug discovery research' that lasted from the 1940s to the 1960s. The four drugs used to treat most cases of TB today – isoniazid, rifampicin, pyrazinamide, and ethambutol – were all first used to treat TB in this period. After the 1960s, there was a lull in investment in TB research for several decades, likely because TB rates in wealthy countries had declined and what cases there were could generally be cured with the new treatments. 'The Global North was very much of the perspective that it's a disease that's waning and 'it's no longer our problem',' Meintjes says. 'It was seen as a disease of poverty; a disease of other countries and money was put into diseases that are common in the Global North.' This all changed around the turn of the century with the HIV epidemic and a resurgence of TB, particularly drug-resistant TB (DR-TB) in Europe and North America, says Meintjes. By definition, DR-TB means that some of the standard drugs used to treat TB no longer work. READ MORE | 'We were the first ones to do it': Innovative SA study takes TB testing to people's homes The renewed interest in TB resulted in a new flurry of TB drug discovery. Maybe most notably in the 2010s, a drug called bedaquiline replaced older DR-TB drugs that were associated with hearing loss. A slightly older antibiotic called linezolid also became a cornerstone of DR-TB treatment. Today, in South Africa 'normal' drug susceptible TB (DS-TB) in adults is treated with a six-month treatment course – consisting of four drugs for two months and then two drugs for the next four months. A four-month treatment course has been shown to work in a clinical trial but is not yet routinely provided in the country. Kids are typically treated for four or six months. DR-TB is treated with anything from three to six drugs, for any time from six to 24 months. How someone's TB is classified is largely determined by which drugs their particular strain of TB is resistant to. Lindsay McKenna, co-director of the TB Project at the Treatment Action Group, suggests thinking of it as a ladder. If the standard four drugs all work for your TB, then you don't have to climb any rungs. If rifampicin doesn't work for you, you have rifampicin-resistant TB (RR-TB) and must climb to the first rung to find drugs that work. If both rifampicin and isoniazid no longer work, you have multi-drug-resistant TB (MDR-TB) and must climb another rung. If you have resistance to even more drugs and you have pre-extensively drug-resistant TB and after that extensively drug-resistant TB. (In practice, TB programmes often classify RR-TB and MDR-TB together since the same medicines are used to treat it.) All of the above treatments are for people who are ill with TB disease. There is also so-called TB preventive therapy, which aims to kill the TB bacteria in the lungs of someone who is infected, but who hasn't yet become ill with TB disease. These preventive treatments typically involve taking one or two medicines for one to six months, depending on the specific treatment regimen. It is possible that new long-acting formulations could allow for an entire course of preventive therapy to be administered as a single injection, though that research is still at an early stage. How the treatments work One reason for the complexity of TB treatment is the bacterium's large and complex genome. Meintjes says that HIV has nine genes, while TB has around 4 000. Having so many genes means the bug has lots of potential to bypass the effect of drugs targeting certain molecules or pathways and still survive. On the other hand, the many genes, at least in theory, provides many potential targets for antibiotics to attack. As noted, to cure TB one typically has to attack the bug with at least three or four different drugs. Meintjes says it is like a group of lions taking down a large buffalo - each one targeting a different part of the buffalo. Along these lines, TB drugs can broadly fit into different categories based on which part of the bacterium they target. Some drugs attack the way the bacterium builds its cell wall, others disrupt how the bug makes its protein, yet others interfere with the way in which the bacterium produces or gets energy, and finally, some sabotages the way TB replicates. As Meintjes explains, isoniazid targets the cell wall of the bacteria, by affecting the formation of molecules within the wall, ultimately causing it to leak and die. Rifampicin targets the genetic mechanisms of the TB bacteria, which prevent it from replicating. Bedaquiline, works by targeting the mechanisms that allow the bug to metabolise energy, essentially starving it of fuel. ALSO READ | Casual encounter: New research challenges thinking on the places where TB is transmitted A class of antibiotics called fluoroquinolones, specifically levofloxacin and moxifloxacin, target the TB bacteria's DNA while it's trying to copy itself and stops that process, explains Furin. Another drug, linezolid, interferes with how the bacteria make proteins, which it needs to survive. It is not entirely clear how some other drugs, like clofazimine and pyrazinamide, work, says Furin. Even when attacking TB with several drugs and from multiple angles like this, it can still take months for all the bacteria in someone's body to be killed and for them to be cured. This is because, according to Furin, sometimes the protective wall formed by the immune system to contain the TB becomes too thick for the drugs to get through. And the environment inside the wall is often very acidic and deactivates some of the drugs that do manage to get in. How treatment could get better Novelist George Orwell, who was diagnosed with TB in 1947, was one of the first people to be treated with streptomycin. 'I am a lot better, but I had a bad fortnight with the secondary effects of the streptomycin. I suppose with all these drugs it's rather a case of sinking the ship to get rid of the rats,' he wrote in a letter at the time. More than 75 years later, TB treatments have improved massively, but drug side effects remain a real problem, especially when treating DR-TB. Some older treatments for TB involved injections of toxic drugs and had horrible side effects, including hearing loss and kidney damage. While newer drugs are better, there are still issues. Linezolid, for example, can cause peripheral neuropathy (painful tingling in the hands and feet) and anaemia. McKenna says none of the TB drugs are 'necessarily a walk in the park' and all come with side effects. This is because of the drugs themselves, the dosages required to kill the TB bacterium, and how long the drugs need to be taken. Because of this, much of the focus in TB research has been on finding drug combinations that can reduce the duration of treatment and the severity of side effects. For Furin, an ideal future regimen includes 'fewer pills' – she's hoping for one pill once a day for no more than 8 weeks, 'fewer side effects', and doing away with the one-size-fits-all approach. Her reference to the 'one size fits all approach' points to one of the central tensions in TB treatment programmes. People with TB often do not get optimal treatment based on the specific characteristics of their own illness. For example, in countries with limited testing for drug resistance, people might be treated with medicines that their specific strain of TB is resistant to. They might thus suffer the side effects of that medicine without any of its benefits. This is less of an issue in South Africa than elsewhere, since the country's health system provides routine testing for resistance against several of the most important TB drugs. There are also questions as to whether everyone really needs to be treated for six months to be cured. A landmark study called TRUNCATE has shown that many people can be cured in two months. The difficulty is that we can't currently predict who will be cured after two months and who will need the full six months, or even longer. Figuring this out, as McKenna points out, would enable more personalised care that would mean fewer people are over or under-treated. Some in the TB world have argued for the development a pan-TB regimen – a combination of three or so drugs that nobody is resistant to and that accordingly could be given to everyone with TB, no matter what strain of TB they have. The benefit of such a pan-TB regimen would be that it would dramatically simplify the treatment of TB if it worked. But the experts interviewed by Spotlight agree that resistance is likely to develop against the drugs in such a regimen, and as such, testing people for drug resistance will remain necessary, as will alternative treatment regimens. Furin also points out that, pharmaceutical companies have a greater incentive to invest in a pan-TB regimen since its potential market share is bigger than for drugs in a more fragmented treatment model. A hard task getting harder One of the biggest obstacles in the way of finding new TB treatments is that there really aren't any reliable shortcuts when it comes to doing the research. With HIV, one can get a good idea as to whether a treatment is working by looking at biomarkers, such as a person's viral load and CD4 count. TB, by contrast, doesn't have any similarly clear biomarkers that tell us whether a treatment is working or not. Arguably, the most promising biomarker for TB is bacterial load - essentially how many bacteria is left in someone's sputum a while after treatment has started. Having a high TB bacterial load is associated with a poor treatment outcome, but the problem is that it is difficult to measure reliably. Without a good biomarker, the only way to measure how well treatment is working is to follow patients for a long time and see if they are cured, and if they are, whether they suffer a relapse. Because of this, TB treatment trials often take several years to complete. Despite these challenges, there has been a good deal of activity in recent years. 'There are about 20 different new drugs in clinical trials at the moment - either early or later phase,' says Meintjes. But much of that momentum might now be lost because of the United States' abrupt slashing of research funding, including much TB research. The US government has, until now, been the largest funder of TB research by some distance. It spent $476 million or more than R8.7 billion through its agencies on TB research in 2023, according to a report by TAG. Many ongoing US-funded TB clinical trials have already been affected, according to McKenna, although there have recently been indications that some research funding might be restored. Where does this leave us? That most people with TB can be cured is something worth celebrating. That treatment for DR-TB has gotten a lot better and shorter over the last two decades is also something to be grateful for. But as we have shown in this Spotlight special briefing, TB is a tough and ancient adversary and keeps adapting. The treatments at our disposal today are far from as good as we'd like them to be. The treatment side effects are often horrible, and many people find it very hard to take these drugs for month after month. We didn't linger on it, but many people who are cured struggle with post-TB lung disease for the rest of their lives - meaning the bug might be gone, but that person's lungs are never the same again. The scientific search for better TB treatments is not a matter of convenience. It is critical to reducing the suffering that several million people will endure just this year. It is also vital for reducing the number of lives that are still being claimed by this age-old disease. And of course, TB will keep mutating, and we will likely see more and more resistance developing against the drugs that we are depending on today. That is why it is imperative that governments, donors, and pharmaceutical companies all maintain and increase their investment in the search for better TB treatments. After all, TB claims more lives than any other single infectious agent on the planet. If that alone doesn't warrant more investment, what does? But there is also a case to be made that we should change the way we conduct TB research. Ideally, more research should be driven, and informed by, what actually matters to people with TB and to people in the communities where TB is rampant. After all, when given the choice, who wouldn't opt for more personalised and more respectful treatment and care? 'The TB community keeps making the same mistakes over and over and then acts mystified when things do not turn out the way they want,' says Furin. 'All the new drugs and new regimens in the world will never be enough if we do not listen to what impacted communities need and follow their lead.' - Additional reporting by Marcus Low. .
Forbes
10-07-2025
- Health
- Forbes
How AI Is Accelerating The Fight Against An Ancient Killer
At the Quezon City Jail in Metro Manila, Philippines, inmates are screened for tuberculosis. Here, a ... More screen displays an x-ray photo taken of one of the inmates. The software uses AI technology to analyze the x-rays for more accurate diagnosis. Tuberculosis (TB) remains the world's deadliest infectious disease – an ancient killer that still claims over a million lives each year, mostly among the world's poorest and hardest-to-reach. Yet we are on the brink of a new era of progress in the fight against the disease. This transformation is driven by a range of innovations, including artificial intelligence (AI). AI is rapidly improving our ability to detect TB in people and places that conventional health systems often fail to reach. With AI-powered software that analyzes digital chest X-rays, health workers can quickly identify people with TB. Mounted on mobile vans, these tools are bringing lifesaving care directly to underserved communities – prisoners, refugees, poor rural communities and the socially marginalized – helping us reach people with the disease who have long been missed by health systems. This is a breakthrough in how we deliver equitable access to TB diagnosis, treatment and care. In Pakistan – one of the countries with the highest TB burden – mobile clinics equipped with AI-assisted digital X-rays screen people on the spot, flagging potential cases for follow-up. This leads to earlier diagnosis, faster treatment, fewer people with TB missed and ultimately, more lives saved. Even better, these platforms aren't limited to detecting TB. They can also identify other lung diseases – pneumonia and whooping cough – as well as other noncommunicable diseases such as cardiomegaly. This is just one example of how AI is driving greater capacity, increasing efficiency and providing novel ways of reaching people where they are. For funders, this translates into a higher return on investment – one tool serving multiple functions, strengthening frontline care and improving efficiency across the health system. Scaling AI effectively will require focused investment to support countries in defining their priorities and shaping their own agenda. As we have seen with pharmaceuticals, the most impactful tools are those developed in collaboration with the people they are supposed to serve. Countries and communities must be supported to lead. Just as our partnerships on biomedical products have advanced health equity, AI must do the same – delivering impact that is not only effective, but also inclusive and equitable. At the Global Fund, we have invested over $193 million between 2021 and 2025 to roll out AI-enabled TB screening in more than 20 countries. But this is just the start. We see AI not only as a tool to beat TB, but as a platform that can power a much more efficient use of resources, support integrated service delivery spanning infectious diseases and noncommunicable conditions, and also strengthen pandemic preparedness and response. Our use of AI in the fight against TB – and the progress our partnership is making in reaching underserved communities – is a compelling proof of concept. The world is making significant gains in finding more people with TB. In 2023, 8.2 million people were identified as ill with the disease, up from 7.5 million in 2022 and 7.1 million in 2019. This is a dramatic improvement over the COVID-era lows of 5.8 million (2020) and 6.4 million (2021). The number of people with TB who go undiagnosed is also shrinking rapidly: just 2.7 million in 2023, down from about 4 million in both 2020 and 2021, and below the 2019 pre-pandemic level of 3.2 million. This progress is imperative. Without treatment, tuberculosis is often fatal, and a person with active, untreated TB can infect up to 15 others in a single year. Every individual we identify and treat brings us one step closer to ending this age-old disease and strengthening global health security. We know that AI can be a powerful tool for good in the fight against deadly infectious diseases. The question is whether our will to deploy it at scale will match its proven effectiveness and its transformative potential. For philanthropists and private sector partners, this is a moment where they can choose to make a huge difference. In resource-constrained settings, philanthropic funding and partnership will be essential to support countries to lead, define, develop and scale AI solutions that work. With this, we can deliver high-impact, scalable solutions that strengthen primary care, enable earlier treatment, and ensure we reach those most in need and those left furthest behind, as we are seeing in TB. That's a powerful promise – but it's one we'll only fulfill if we get it right. AI must be developed and deployed responsibly, with transparency, respect for local context and equity as its guiding principles. It must work for the people who are often excluded from the benefits of innovations. For donors seeking to invest in high-impact innovation, this is an opportunity to support solutions that are not only effective but truly transformational, saving lives and helping to build a healthier, more equitable future for all.
Medscape
10-07-2025
- Health
- Medscape
Bedaquiline-Resistant TB Treatment Shows Limited Success
TOPLINE: Patients with bedaquiline-resistant tuberculosis had a significantly longer time to sustained sputum culture conversion than those with bedaquiline-susceptible tuberculosis. Only half of the patients achieved tuberculosis-free survival at 18 months, whereas nearly one fourth died. METHODOLOGY: Researchers conducted a retrospective cohort study to assess treatment outcomes in patients with bedaquiline-resistant tuberculosis at a high HIV-burden setting in South Africa between January 2018 and June 2023. They analyzed 82 patients (median age, 38 years; 51% women; 70% HIV positive) with rifampicin and bedaquiline-resistant tuberculosis confirmed with a sputum culture-positive Mycobacterium tuberculosis isolate on phenotypic drug susceptibility testing. They also enrolled an equal number of control patients with rifampicin resistant, bedaquiline-susceptible tuberculosis — matched by age, HIV status, and baseline culture status — from another study at the same facility. The main outcome measures were time to sputum culture conversion, a modified World Health Organization (WHO)-defined unfavorable outcome, and tuberculosis-free survival. Sputum culture conversion was defined as the date of the first of two sputum samples with negative M tuberculosis cultures, regardless of whether they were consecutive, and with no intervening positive culture. TAKEAWAY: The median time to sustained sputum culture conversion was significantly longer in the bedaquiline-resistant group than in the bedaquiline-susceptible group (175 days vs 32 days; log-rank P < .0001). Overall, 67% of patients with bedaquiline-resistant tuberculosis had a WHO-defined unfavorable outcome, of which 43% accounted for treatment failure defined as absence of culture conversion by 6 months. Tuberculosis-free survival rates among patients with bedaquiline-resistant tuberculosis were 50% at 6 months and 52% at 18 months. Deaths were reported in 10% and 23% of patients at 6 and 18 months, respectively. Extended bedaquiline use in patients with bedaquiline-resistant tuberculosis was linked to reduced 18-month mortality (adjusted hazard ratio, 0.74; 95% CI, 0.62-0.88). IN PRACTICE: 'The findings also serve as a call to action on several fronts. Chief among these is the need to access novel tuberculosis drugs that are both effective and acceptable for this population,' the authors of a linked commentary wrote. 'Compassionate use of new drugs to replace these injectable agents would be a logical place to start,' they added. SOURCE: The study was led by Lindokuhle Mdlenyani from the Department of Health, Eastern Cape Province, East London, South Africa, and Zahraa Mohamed from the Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, Cape Town, South Africa. It was published online on June 18, 2025, in The Lancet Infectious Diseases. LIMITATIONS: The study's generalizability was limited by its single-center design. The matched analysis was hindered by population differences in fluoroquinolone resistance and prior treatment episodes between groups. Documentation of treatment timing for bedaquiline-resistant tuberculosis was inconsistent in medical records. DISCLOSURES: This study received support from the South African Medical Research Council. One author was employed by the Council. Another author disclosed serving as an independent member of the drug safety monitoring board for the Bill & Melinda Gates Medical Research Institute and Otsuka Pharmaceutical trials, and another reported receiving grants from the Bill & Melinda Gates Foundation and the National Institutes of Health. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
