War against TB heightened as efforts to expand access to shorter TB prevention advances elimination

The Unitaid-funded IMPAACT4TB Consortium, led by the Aurum Institute, announced today that it will provide 250,000 patient courses of short-course rifapentine-based preventive treatment regimens to seven countries to help prevent tuberculosis (TB).

The patient courses will include the three-month 3HP regimen, and the even shorter 1HP, which is only taken for 28 days. This contribution is part of the Consortium’s ongoing efforts to end TB and improve global health outcomes.

The seven countries set to benefit from this initiative are Brazil, Haiti, India, the Maldives, Nigeria, Tanzania and Zambia. This supply of rifapentine-based preventive treatment regimens is expected to contribute significantly to the global effort to reduce the incidence of TB, which continues to be a major public health challenge worldwide.

“Despite commitments to end tuberculosis as a global epidemic by 2030, the disease remains the world’s deadliest infectious disease, killing around 4,400 people every day,” said Prof Gavin Churchyard, CEO of Aurum Institute and the principal investigator of the IMPAACT4TB project. “TB prevention is a cornerstone of any effort to eliminate TB, and we hope that these 250,000 patient courses will contribute to countries’ efforts to finally make TB a disease of the past.”

About one-quarter of the world’s population is infected with a form of TB that causes no symptoms and is not contagious.

Without treatment, 5% to 10% of those infected will develop active TB, which causes severe illness and can be transmitted from person to person through the air. TB preventive treatment regimens lower the risk of progression to TB in people at risk, including children, pregnant women, and people living with HIV.

In recent years, new and shorter rifapentine-based TB preventive treatment regimens have been recommended by the World Health Organization (WHO) and are becoming increasingly available.

Currently, over four million patient courses are being manufactured annually. These shorter regimens are associated with higher treatment adherence, completion, and outcomes.

In fact, people taking shorter regimens are up to three times more likely to complete their course than those on longer regimens—leading to better outcomes and more lives saved.

In many high-burden TB countries, these new short-course TB preventive treatment regimens are modeled to be cost-effective for both people living with HIV and household contacts of all ages, regardless of whether contact investigation is already in place.

“The seven countries receiving these regimens have expressed their readiness not only to identify underserved and at-risk populations and ensure they receive these newer regimens but also to invest in strengthening systems around contact tracing and learning lessons on how to improve TB preventive treatment uptake and coverage,” said Dr Philippe Duneton, Executive Director of Unitaid.

These patient courses consist of shorter rifapentine-based regimens, including two treatment options: 3HP, a three-month oral treatment taken once weekly, and 1HP, a 28-day oral treatment taken once daily, increasing choice for patients needing TB preventive treatment.

Access to rifapentine-based regimens has been established in 71 countries, with over three million patient courses purchased to date. However, despite this progress, key groups and areas are still behind the target.

The IMPAACT4TB Consortium’s provision of patient courses, which was made possible due to cost savings achieved over the past five years, is part of the Consortium’s broader strategy to reduce the cost of rifapentine.

Among other things, by working with global partners and manufacturers, the Consortium helped significantly reduce the access price of a three-month patient course of weekly rifapentine and isoniazid, from US$72 to US$14.25.

Meanwhile, In 2022, several of the high TB burden countries—including Brazil, Nigeria, India, and Indonesia—diligently increased the number of people diagnosed and enrolled in TB treatment, reaching and exceeding the numbers seen before the COVID-19 pandemic.

According to preliminary data from the Stop TB Partnership, in 2022 the gap between the estimated number of people with TB and those diagnosed and treated was the lowest ever—with less than 3 million missing people with TB. This gap was 3.2 million in 2019, 4.3 million in 2020, and 4.2 million in 2021.

Despite this progress, last year, as the COVID-19 pandemic ebbed, TB regained its tragic title as the world’s biggest infectious disease killer due to setbacks in diagnosis and treatment over the past three years.

This year is critical as the international community prepares for the next UN High-Level Meeting (UNHLM) on TB taking place in September 2023, the second such event held at the UN General Assembly.

“With the world regaining strength as the COVID-19 pandemic wanes, ending TB as a global health threat is a critically important goal,” said Dr. Lucica Ditiu, executive director of the Stop TB Partnership.

“We have new innovations now to help us save lives—new diagnostic tools, shorter, less toxic treatment regimens, and new digital tools—and when we add the political muscle that the UNHLM will gather to the many dedicated health care professionals already in the front lines, ending TB looks increasingly possible.”

At the first UNHLM in 2018, 15 Heads of State and Heads of Government joined 1,000 participants in pledging to increase efforts to end TB.

While the COVID-19 pandemic upended many of these commitments, the upcoming UNHLM on TB has already seen momentum in bringing the world together to renew this important goal.

In fact, experts, scientists, donors, medical workers, and advocates worldwide are already making up the ground, which was lost due to the COVID-19 pandemic and economic downturn.

“It is absolutely inspirational to see so many nations stepping forward with their own national plans to end TB,” said Austin Arinze Obiefuna, executive director of the Afro Global Alliance in Ghana and vice chair of the Stop TB Partnership Board. “TB is a disease that hits the poorest parts of the world hardest. It will not simply go away; instead, we need all governments to join us in stopping this disease from wrecking people’s lives, their families, and their livelihoods.”

New tools and investments

In the past few years, new tools to combat TB have cleared regulatory approvals and entered the marketplace. Multilateral institutions and development agencies are working to make these innovations more accessible and available to the countries and regions most in need.

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