Treat TB

After conducting extensive research to identify the gaps in international TB control, the TREAT TB Initiative has now moved into its implementation phase. The Initiative’s priority activities include evaluating a standardized regimen for patients with multidrug-resistant tuberculosis (MDR-TB), assessing the impact of new diagnostic tools in high-burden settings, and building the capacity of researchers in low-income countries to conduct independent operational research.

With support from the U.S. Agency for International Development (USAID), the International Union Against Tuberculosis and Lung Disease launched the Technology, Research, Education and Technical Assistance for TB Initiative (TREAT TB) in October 2008. By aiming to build a successful research partnership model focused on operational research, the Initiative had a unique and ambitious workplan from its inception.

From late 2008 through January 2011, TREAT TB examined the evidence for new and existing approaches and tools for TB diagnosis and treatment through global consultation meetings and systematic reviews.  The 2009 Global Consultation on Re-treatment Regimens and the 2010 Global Consultation on Digital Radiography resulted in priority research agendas on these respective topics and several scientific studies, some of which have already published their findings.

In addition to the research activities generated by these TREAT TB events, several systematic reviews are scheduled to be published in peer-reviewed journals later this year. In 2010, TREAT TB commissioned reviews on:  “The Use of Microscopic Observation Drug Susceptibility (MODS) Assay or Thin Layer Agar (TLA) Techniques for the Diagnosis of Active Tuberculosis and/or for Drug Sensitivity Testing” ; “The Urinary lipoarabinomannan (LAM) Antigen Detection for the Diagnosis of Tuberculosis” ; and “The Use of Interferon-Gamma Release Assays (IGRAs) for the Detection of Mycobacterium Tuberculosis (M.tb) Infection in Children.”

The Operational Research Assistance Project in South Africa
In South Africa, TREAT TB and its local partner, the Desmond Tutu TB Centre (DTTC), are implementing the four-year Operational Research Assistance Project (ORAP) with generous funding from the USAID mission in South Africa.  Since the start of the project in 2010, DTTC has obtained support from a wide range of national and provincial stakeholders.  Currently, ten protocols focused on priority research issues for TB control efforts in South Africa, as determined by the Department of Health, are being implemented in every province of the country.

TREAT TB International Studies: PROVE IT and STREAM
TREAT TB is also conducting two major international studies.  The first, Policy Relevant Outcomes from Validating Evidence on Impact (PROVE IT), will assess the impact of rolling out the new diagnostic tool Line Probe Assays in Brazil, Russia, and South Africa.  PROVE IT has already begun in South Africa, where DTTC is leading this research activity.  TREAT TB’s partner in the Russian Federation, the Northern State Medical University, is scheduled to begin the study in Arkhangelsk in May 2011.  Starting in June 2011, the Rio de Janeiro-based non-governmental organization REDE-TB will implement PROVE IT in three provinces in Brazil.

The second major study is a clinical trial of a shortened, standardized treatment regimen of anti-tuberculosis drugs for patients with multiple drug-resistant tuberculosis known as STREAM.  STREAM will determine if a nine-month regimen that resulted in notable success in Bangladesh can achieve similar results in other settings. The Union is sponsoring this trial, which will be implemented in four high-burden countries by the Medical Research Council of the United Kingdom. STREAM is set to begin patient recruitment this summer.

The Impact of TREAT TB
By engaging a number of strategic partners in the TREAT TB Initiative and widely distributing its research findings, The Union will provide information that assists global and national policymakers to evaluate the necessary evidence when making decisions regarding the most appropriate diagnostic tools and optimal patient management strategies.