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New tools and approaches to drug-resistant TB | Collections | MSF Science Portal
New tools and approaches to drug-resistant TB

New tools and approaches to drug-resistant TB

The World Health Organization estimates that 410,000 people developed a drug-resistant tuberculosis infection (DR-TB) in 2022, only 40% of whom were diagnosed and started on treatment—and only 63% then cured. Given all these points of failure, innovation in preventing, diagnosing and treating DR-TB cannot come fast enough.

To mark World TB Day (24 March 2024) the content collection linked below highlights recent work by MSF and collaborators to help change this grim picture. The TB-PRACTECAL and endTB studies delivered robust evidence for shorter, safer, more effective drug regimens that are already saving lives worldwide. Other studies explore new approaches to preventive treatment and simpler, quicker, accurate detection of TB and drug resistance—especially among difficult-to-diagnose populations such as children and people living with HIV.

But to impact DR-TB globally these innovations must become widely accessible. This requires changes on many fronts, as described in an accompanying Collection (Expanding Access to Lifesaving New TB Tools).

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World NTD Day

World NTD Day

Neglected tropical diseases (NTDs) impact nearly 1.7 billion people each year, causing serious illness or lifelong disability among many—often leading to stigma and exclusion—and killing an estimated 200,000. The vast majority of sufferers live in the world’s poorest countries.


The World Health Organization’s NTD roadmap 2021-2030 aims to address 20 tropical diseases through prevention, control, elimination, and/or eradication. But despite some progress, reaching all its targets will take better, far more accessible diagnostics and treatments along with more robust strategies, political commitment and resources.


To mark World NTD Day, this collection spotlights work by MSF and collaborators on improving approaches to snakebite envenoming, kala azar and noma. One study presents an innovative artificial intelligence-based snakebite diagnostic tool, while others evaluate shorter, less toxic drug regimens or different models of care. Several commentaries advocate for national/regional strategies adapted to contexts ranging from remote villages to active conflict zones. Another crucial factor is the climate crisis, which is intensifying the transmission and geographic spread of many NTDs.

Diabetes care in humanitarian settings

Diabetes care in humanitarian settings
Expanding access to lifesaving new TB tools

Expanding access to lifesaving new TB tools
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Diabetes affect hundreds of millions of people worldwide, a large majority of them living in low- and middle-income countries. Yet finding effective strategies, tools and policies for effectively managing this chronic illness—especially amid war, displacement or exclusion from care—is a neglected area of humanitarian medicine. Here we present a cross-section of work on this front by MSF and collaborators. Several studies assess the shift towards community-based, nurse-led models of care in rural settings. Others explore obstacles to diabetes care for war refugees living in camps in Jordan or Lebanon, highlighting how health programs can adapt to their needs. The demonstration that insulin retains potency for 30 days if cooled without refrigeration is opening doors to more patient self-management, as a case study in remote South Sudan shows. At the same time, MSF and others call for regulatory and financing policies that make diabetes medications and supplies cheaper, better adapted to humanitarian settings, and far more available to patients whose lives depend on them.
Many settings with a high burden of drug-resistant tuberculosis (DR-TB) lack access to advanced diagnostics and to groundbreaking new treatments. The Collection linked below spotlights work by MSF and collaborators to analyze barriers, identify gaps, and accelerate the roll-out of these tools to people whose lives hang in the balance. Several reports examine price, regulatory, and patent obstacles that persist despite considerable public investment into developing many of these tools. Other authors examine critical remaining weaknesses in care pathways—especially in screening and diagnosis, and particularly in children. Several studies describe new strategies that could be part of the solution, from a pilot program in Tajikisttan that trains family caregivers to treat children with DR-TB at home, to a person-centered care model adapted to a conflict zone in Afghanistan. Lastly, initial findings demonstrate that pregnant women—another vulnerable population—can be effectively treated for DR- and multidrug-resistant TB, improving maternal outcomes without harming neonates.
Journal Article
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Research

Short oral regimens for pulmonary rifampicin-resistant tuberculosis (TB-PRACTECAL): an open-label, randomised, controlled, phase 2B-3, multi-arm, multicentre, non-inferiority trial

Nyang'wa BT, Berry C, Kazounis E, Motta I, Parpieva N,  et al.
2024-02-01 • Lancet Respiratory Medicine
2024-02-01 • Lancet Respiratory Medicine
BACKGROUND
Around 500,000 people worldwide develop rifampicin-resistant tuberculosis each year. The proportion of successful treatment outcomes remains low and new treatments are nee...
Journal Article
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Research

Nine-month, all-oral regimens for rifampin-resistant tuberculosis

Guglielmetti L, Khan U, Velasquez GE, Gouillou M, Abubakirov A,  et al.
2024-01-29 • medRxiv
2024-01-29 • medRxiv

BACKGROUND

Aft...

Journal Article
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Research

Detection of Mycobacterium tuberculosis complex using the Xpert MTB/RIF Ultra assay on the stool of pediatric patients in Dushanbe, Tajikistan

Rekart ML, Mun L, Aung A, Gomez D, Mulanda WK,  et al.
2023-01-09 • Microbiology Spectrum
2023-01-09 • Microbiology Spectrum
We report the findings of a prospective laboratory diagnostic accuracy study to evaluate the sensitivity, specificity, and predictive values of the Xpert MTB/RIF Ultra assay for Mycobact...
Conference Material
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Slide Presentation

Pregnancy outcomes in patients undergoing drug-resistant tuberculosis treatment in two closely monitored cohorts

Lachenal N, Hewison CCH, Berry C, Mitnick CD, Ahmed SM,  et al.
2022-05-11 • MSF Scientific Days International 2022
2022-05-11 • MSF Scientific Days International 2022
Conference Material
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Abstract

Can point-of-care ultrasound support tuberculosis diagnosis in children? The experience of MSF in Guinea-Bissau

Moreto-Planas L, Sagrado MJ, Mahajan R, Gallo J, Biague E,  et al.
2022-05-11 • MSF Scientific Days International 2022
2022-05-11 • MSF Scientific Days International 2022
INTRODUCTION
Tuberculosis (TB) is an important cause of morbidity and mortality in children and over 50% of childhood TB remains undiagnosed every year. As microbiological confirmati...
Journal Article
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Commentary

Being heard on all-oral therapy for resistant tuberculosis

Furin J, Isaakidis P
2022-05-02 • Lancet Infectious Diseases
2022-05-02 • Lancet Infectious Diseases
Journal Article
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Research

Feasibility and acceptability of using the novel urine-based FujiLAM test to detect tuberculosis: A multi-country mixed-methods study

Rucker SCM, Lissouba P, Akinyi M, Lubega AV, Stewart RC,  et al.
2022-05-01 • Journal of Clinical Tuberculosis and Other Mycobacterial Diseases
2022-05-01 • Journal of Clinical Tuberculosis and Other Mycobacterial Diseases
BACKGROUND
The novel urine-based FujiLAM test identifies tuberculosis in HIV-positive patients but may be challenging to use at point-of-care (POC).

OBJECTIVES
We assess...
Journal Article
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Research

Whole genome sequencing has the potential to improve treatment for rifampicin-resistant tuberculosis in high burden settings: a retrospective cohort study

Cox HS, Goig GA, Salaam-Dreyer Z, Dippenaar A, Reuter A,  et al.
2022-02-16 • Journal of Clinical Microbiology
2022-02-16 • Journal of Clinical Microbiology
BACKGROUND
Treatment of multidrug-resistant or rifampicin-resistant tuberculosis (MDR/RR-TB), although improved in recent years with shorter, more tolerable regimens, remains largely...
Journal Article
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Commentary

Tuberculosis preventive therapy for children and adolescents: an emergency response to the COVID-19 pandemic

Mohr-Holland E, Douglas-Jones B, Apolisi I, Ngambu N, Mathee S,  et al.
2021-03-01 • Lancet Child and Adolescent Health
2021-03-01 • Lancet Child and Adolescent Health
Journal Article
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Commentary

Introducing new and repurposed TB drugs: the endTB experience

Seung KJ, Khan UT, Varaine FFV, Ahmed SM, Bastard M,  et al.
2020-10-01 • International Journal of Tuberculosis and Lung Disease
2020-10-01 • International Journal of Tuberculosis and Lung Disease
In 2015, the initiative Expand New Drug Markets for TB (endTB) began, with the objective of reducing barriers to access to the new and repurposed TB drugs. Here we describe the major imp...