In 2021, an estimated 10.6 million people fell ill with tuberculosis globally, marking the first increase in global case numbers in over a decade. Interruptions to health care services and surveillance systems due to COVID-19 have reduced access to TB treatment and impaired case detection and monitoring programs. Despite being a preventable and curable disease, 1.6 million people died from TB in 2021, up from 1.4 million in 2019. Ending the Tuberculosis Epidemic by 2030 is among the health targets of the United Nations Sustainable Development Goals (SDGs). Most people living with TB live in low- and middle- income countries. Children and adolescent TB result in an estimated 1.1 million infections and are often overlooked. The risk of active TB is greater in persons with impaired immune systems; people living with HIV are 18 times more likely to develop TB and represent a disproportionate share of TB-related deaths.
Diagnostic testing for TB has proven difficult. The most sensitive, gold standard test is a mycobacterial culture, which has a four to six week turn-around-time and requires sophisticated laboratory infrastructure. Molecular sputum tests are more common, but perform poorly among children and those living with HIV, who often have a lower bacterial burden (paucibacillary infection).
Concerningly, decades of TB medication use have led to the emergence of drug resistant strains. Multidrug-resistant tuberculosis (MDR-TB) is treated by second-line drugs; however, the availability of these medications is limited, and treatment of MDR-TB requires specific chemotherapy at a high cost to health systems and patients.
In order to achieve global TB control and elimination, advancements in rapid TB diagnostics that can be easily deployed in low-resource settings and are sensitive to paucibacillary infections are urgently needed. Rapid detection of antimicrobial resistance will also be critical to curbing the rise in MDR-TB cases and ensuring better treatment outcomes.
Our Center and its affiliation with the Infectious Disease Institute in Kampala, Uganda have worked to evaluate TB diagnostics, improve diagnoses of TB in resource-limited settings, and evaluate the impactful use of rapid POC diagnostics.