Tuberculosis prevention in low- and middle-income countries

98% of tuberculosis infections and deaths occur in low- and middle-income countries. Long oral regimens and poor patient acceptability contribute to ineffective and underutilised prevention therapies. Effective short courses do exist but are costly and require daily or weekly intake resulting in less than 50% completion rate despite the potential for cure. The LONGEVITY consortium's aim for TB is to prevent the onset of TB disease by introducing an innovative prevention strategy for LMICs, which currently bear a staggering 98% of the global TB burden. This initiative aims to make a significant impact on improving healthcare outcomes.

The Tuberculosis Burden

  • 98% of tuberculosis infections and deaths occur in low- and middle-income countries.
  • A total of 1.5 million people died from tuberculosis (TB) in 2020 (including 214 000 people with HIV).
  • TB is the 13th leading cause of death and the second leading infectious killer after COVID-19 (above HIV/AIDS).
  • In 2020, an estimated 10 million people fell ill with tuberculosis worldwide. 5.6 million men, 3.3 million women and 1.1 million children.
  • Globally, 1.1 million children fell ill with TB in 2020. Child and adolescent TB is often overlooked by health providers and can be difficult to diagnose and treat.
  • The 30 highest TB burden countries accounted for 86% of new TB cases in 2020. Eight countries account for two thirds of the total, with India leading the count, followed by China, Indonesia, the Philippines, Pakistan, Nigeria, Bangladesh and South Africa.
  • Funding in low- and middle-income countries that account for 98% of reported TB cases falls far short of what is needed. Spending in 2020 amounted to US$ 5.3 billion, less than half (41%) of the global target.

Source: World Health Organization: Tuberculosis

LONGEVITY and Tuberculosis

Our strategy is to prevent the spread of TB in LMICs by treating latent TB infection (LTBI). In LTBI, TB bacteria are present in the body, but the immune system may be able to control their growth and prevent them from causing active disease. People with LTBI do not feel sick and cannot spread the bacteria to others. However, for some people, especially if the immune system becomes weakened (such as in people with HIV or who are receiving certain medications), the bacteria can become active and cause active TB disease. This is why people with LTBI are recommended to take TB Preventive Treatment (TPT) to get rid of the bacteria.

Currently, long oral regimens and poor patient acceptability contribute to ineffective and underutilised prevention therapies. We are targeting a one-time injectable regimen to simplify administration for patients, and healthcare programmes to reduce incidence of active disease in low- and middle-income countries (LMICs). 

Effective short courses do already exist but are costly, require daily or weekly intake, and have a completion rate of less than 50%. Factors such as stigma and complexity in treatment programmes create access barriers, with patients reluctant to seek treatment.

Long-acting injectable drug delivery will contribute to reducing these barriers. Using long-acting injectable modes of drug delivery is a discreet way to take medication, thereby reducing issues related to stigma in TB affected communities.

An administration of between one and two long-acting injections may replace current oral prevention regimens which can last between one and thirty-six months, and sometimes involve taking hundreds of tablets in total. A simpler regimen will improve adherence and completion rates, thereby reducing the number of patients requiring complex therapies for active disease.


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