Investing in TB prevention strategies with Long-Acting injectables
Susan Swindells is Professor of Internal Medicine in the Section of Infectious Diseases at the University of Nebraska Medical Center, USA. She is a contributing investigator on TB clinical development for the LONGEVITY project. A native of England, Dr. Swindells earned her medical degree from University College London in 1977, with postgraduate training in England and at the University of Washington in Seattle. A clinician and active researcher, Dr. Swindells has many years’ experience in HIV-related translational and clinical research, with a special interest in tuberculosis co-infection.
The theme for World TB Day 2022 is ‘Invest to End TB. Save Lives’. More investment will save millions of lives and accelerate the end of the TB epidemic. Where do you see the most urgent requirement to invest resources to ramp up the fight against TB?
To be honest, it is difficult to choose the most urgent requirement. We need resources to ramp up the fight against TB at every level and at every stage of disease. TB research has been chronically underfunded for many years, and we need more investment in basic, translational and clinical research. Then resources are needed to actually implement any new treatment or prevention strategies that are developed. Many TB treatment programs lack basic infrastructure and access to diagnostics and medications. TB is generally a disease that afflicts people living in poverty, and poor countries always need more investment in public health services and healthcare delivery overall.
Until the COVID19 pandemic, TB was recognised as the world’s most infectious killer. What impact has the pandemic had on recent progress towards ending TB?
COVID-19 has had devastating impact on progress towards ending TB. For the last few years prior to 2020, we had been making small but real improvements, and progress towards the goal of ending the TB epidemic. Since the pandemic struck, all of this progress has been dramatically reversed. This includes any kind of TB prevention strategies, in diagnosing of TB cases, and in provision of treatment. Modeling studies predict that COVID-19 will set back global efforts to end TB by five to eight years.
The LONGEVITY project is making a significant investment into a TB prevention strategy by adopting Long-Acting injectable drug delivery. What benefits do Long-Acting regimens have over the current oral medicines?
Currently available TB preventive strategies work well, but are woefully underutilised. Some of the main barriers to use include length of the treatment required, risk of adverse events, and concern about development of drug-resistant TB in those that do not complete the treatment course.
In addition to providing a much-needed choice of treatment for patients and programs, long-acting drug delivery can also address concerns about length of treatment, and failure to complete the treatment regimen. If patients could just receive a single long-acting injection to complete the treatment course, this would be a real game changer.
Long-Acting drug delivery is a relatively modern innovation that can have a huge impact on healthcare provision in low- and middle-income countries. Is there any indication of how these new formulations will be accepted in populations with high TB burden?
Looking at other disease states, we see high levels of acceptance and enthusiasm amongst patient and providers, for example using hormonal contraception. A more recent example is in HIV care, where availability of long-acting drug delivery for antiretroviral therapy has been received with great enthusiasm by patients. At present, we do not have any data about how populations in countries with high TB burden would view long-acting drug delivery, but plan to collect this information as part of the Longevity program
The World Health Organisation set a target of “No TB patients and their households facing catastrophic costs as a result of TB disease”. This target was sadly missed in 2020. How can Long-Acting regimens affect the cost of TB on households in low- and middle-income countries?
If we can successfully deploy long-acting TB preventive regimens globally, this will have major impact on costs for households in lower middle income countries. Accessing TB prevention will be much simpler, and the most important advantage will be prevention of TB disease. Inability to work and bring in income because of either having TB, or having to take care of child or family member with TB is the major driver of costs to households.
The LONGEVITY project aims to simplify TB preventative treatment and reduce the number of patients requiring complex therapies for active disease.
A potential one-time injectable regimen will simplify administration for patients and programmes and reduce incidence of active disease in low- and middle-income countries.