Tuberculosis prevention in low- and middle-income countries

98% of tuberculosis infections and deaths occur in low- and middle-income countries (LMICs). 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.

Tuberculosis is an infectious disease caused by bacteria that often impacts a person's lungs. The World Health Organisation believe that around 25% of the planet's population have been infected by TB bacteria and that around 5-10% will develop TB disease and symptoms. Due to its connection to the lungs it is spread by coughing and sneezing of people with the infection, but people who have the bacteria but not TB disease are not infectious.  

We know that TB can be fatal without treatment.

 

Symptoms of Tuberculosis

When someone has TB disease the symptoms can be mild for a few months, so they could easily be unaware that they are spreading the disease.

Common symptoms of TB include:

  • prolonged cough (sometimes with blood)
  • weakness
  • fatigue
  • chest pain
  • fever
  • night sweats
  • weight loss

The symptoms of TB disease can change based on where in the body TB become active. While it is often located in the lungs it can become active in other areas including the kidneys, brain, spine or skin.

 

The Tuberculosis Burden

  • 98% of tuberculosis infections and deaths occur in low- and middle-income countries.
  • A total of 1.3 million people died from TB in 2022 (including 167 000 people with HIV).
  • Worldwide, TB is the second leading infectious killer after COVID-19 (above HIV and AIDS).
  • In 2022, an estimated 10.6 million people fell ill with tuberculosis (TB) worldwide, including 5.8 million men, 3.5 million women and 1.3 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.
  • Multidrug-resistant TB (MDR-TB) remains a public health crisis and a health security threat. Only about 2 in 5 people with drug resistant TB accessed treatment in 2022.
  • Global efforts to combat TB have saved an estimated 75 million lives since the year 2000.
  • US$ 13 billion is needed annually for TB prevention, diagnosis, treatment and care to achieve the global target agreed at the 2018 UN high level-meeting on TB.
  • Ending the TB epidemic by 2030 is among the health targets of the United Nations Sustainable Development Goals (SDGs).
  • TB is present in all countries and age groups.
  • TB is curable and preventable.

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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