Development of New Tools
Progress in improving the tools for the diagnosis, treatment and prevention of TB has been very slow. Sputum smear microscopy for the diagnosis of infectious TB cases represents technology that is over 100 years old. There has been no new anti-TB drug since the introduction of rifampicin in the 1970s. There has been little progress toward a new anti-TB vaccine since the development of BCG in the 1920s. The development of new diagnostic techniques, anti-TB drugs and vaccines has the potential to make a dramatic impact on TB control.
Diagnosis
Sputum smear microscopy is slow and labour-intensive. There is a need for rapid, robust, simple and low-cost diagnostic tests for TB that are suitable for use in high prevalence countries. Until recently there have been few efforts to develop such tests. Simplified diagnosis would make the patient's entry point for access to the DOTS strategy much easier, more reliable and more widely available.
An accurate diagnostic test for smear-negative pulmonary TB is also needed because of the increase in reported cases of this form of TB in association with the TB/HIV co-epidemic.
Treatment
There is a need for a single combination product (a single tablet or capsule) that includes all four drugs for the initial phase of treatment. The development and widescale use of this combination product has the potential to reduce the risk of further emergence of anti-TB drug resistance. There is a need for shorter courses of anti-TB treatment, since the current lengthy treatment (at least six months) represents one of the most important obstacles to ensuring completion of treatment and cure. The development of new anti-TB drugs has the potential to simplify and shorten anti-TB treatment, as well as to expand the range of drugs available to counter drug resistance.
Prevention
Vaccines
The currently available BCG vaccine is valuable in substantially decreasing the risk of severe and disseminated forms of TB in children. However BCG appears to be of little if any benefit in adults in decreasing the risk of TB infection or the risk of active disease in those with TB infection. There is a need for vaccines that provide protection against both infection and disease. The development and widespread use of such vaccines would dramatically reduce the number of TB patients who need the DOTS strategy.
Preventive therapy in HIV-infected individuals
Preventive therapy against tuberculosis involves the use of the anti-TB drug isoniazid given to individuals with latent TB infection in order to prevent the progression to active disease. Several large randomized controlled trails have demonstrated that preventive therapy can be effective in preventing TB in individuals dually infected with HIV and M. tuberculosis. WHO and UNAIDS have recommended that preventive therapy be a part of the package of care offered to people liviug with HIV, but that it only be used only in settings where it is possible to provide testing and counselling for HIV and to exclude active TB cases and to ensure appropriate monitoring and follow-up. The feasibility and cost-effectiveness of large-scale use of preventive therapy in resource-poor countries still needs assessment. The priority for TB control programmes continues to be tbe detection and cure of infectious TB cases.
Mobilizing New Partners
The sustainability fo TB control programmes may rest on mobilizing new partners to advocate for effective TB control policies and funding. All feasible and practical inter-sectoral allies--from national policy and decision makers to local religious and social groups--can raise awareness and demand for effective TB control, assist in the delivery of resources and services, and strengthen community participation.
For example, nongovernmental organizations can be mobilized to provide funding and service delivery, while religious organizations, civic groups, and disease support groups (such as HIV/AIDS patient counselling groups) can observe patients taking their medications for provide psychosocial support.
