Catching up: TB research round-up

Wednesday, November 5, 2014

Similar to yesterdaBy's round-up of HIV-focused studies, this is a collection of recently-published studies on TB.

A major global health item this week was a study examining the rising incidence of diabetes in the developing world and its link to TB:
Diabetes rates are rising everywhere; a part of an overall increase in non-communicable diseases. As the world gets better, more people suffer lifestyle diseases. These include diabetes and heart disease, and other ailments that go along with a population that is living longer, like cancer.

The non-communicable diseases burden in low-income countries is expected to increase to 69 percent by 2020, from 47 percent in 1990. That is cause for concern by itself. Some 384 million people have diabetes and it will reach nearly 600 million cases by 2035. The diseases often associated with unhealthy diets, is particularly burdensome in low- and middle-income countries, where more than 80 percent of the 3.4 million annual diabetes deaths occur.

Toss in the potential for increased risk of TB and things get worse. The risk of contracting active TB is up to three times higher for people who have diabetes, also making them carriers of a contagious and potentially deadly infection.

Immediate action is needed to fend off a “looming co-epidemic,” according to a report released by The Union and the World Diabetes Foundation.

A new anti-TB drug, bedaquiline, has shown promise in treating MDR-TB and XDR-TB:
The study population comprised 35 people who were provided with compassionate access to the drug between 2011 and 2013. After six months of therapy, 97% of study participants with culture-positive pulmonary TB at baseline had achieved culture conversion.
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Bedaquiline is a new antibiotic with activity against drug-resistant strains of TB. It was approved by the Food and Drug Administration (FDA) in the United States and the European Medicines Agency after it demonstrated efficacy in clinical studies.
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The authors note that the efficacy was better than that observed in clinical trials.

Sputum-smear conversion occurred in 48% and 69% of participants at three and six months, respectively.

The median time to culture conversion was 85 days.

An analysis published in Lancet Infectious Diseases showed that increased expenditure on social protection programs (e.g., sickness, disability and unemployment benefits, old age pensions, housing support) is associated with improved TB control:
With this new policy in mind, an international team of investigators looked at the relationship between social protection expenditure and TB control between 1995 and 2012 in the 21 countries that are now members of the EU.
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Overall, the authors found a strong relationship between increased per-person expenditure on social protection and lower TB incidence (p = 0.003) and mortality (p = 0.01) rates.

Cross-national analysis controlling for GDP and expenditure on public health showed that each $100 increase per person in social protection expenditure was associated with a fall per 100,000 population in the number of TB notifications (-1.53%, p = 0.01), TB incidence rates (-1.70%, p = 0.02), non-HIV-related TB mortality rates (-2.74%, p = 0.01) and all-cause TB mortality rates (-3.08, p = 0.01).

“Our findings add to the empirical evidence that investing in social protection is justified, not just because it is fair and protects the most vulnerable populations, but also because it contributes to measures to reduce the global burden of tuberculosis,” write the authors. “Social protection programmes are likely to provide a vital component of a robust tuberculosis prevention strategy, especially for vulnerable groups.”

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