Tuberculosis (TB) has been a deadly presence throughout the history of mankind. Today, mycobacterium tuberculosis is thought to infect one-third of the world’s population and it’s the world’s most common cause of death from infectious disease. While governments in high-income countries were largely successful in eliminating TB, the disease remains stubbornly entrenched in many low and middle income countries. In 2014, more than 95% of the 1.5 million TB-related deaths occurred in developing countries.
Drug-resistant TB (DR-TB) and multi-drug resistant TB (MDR-TB) is a growing menace, affecting an estimated 480,000 people in 2015. Current treatment regimens are up to two years long, costly and have significant side effects. In real world treatment settings – i.e. not clinical trials – only 52% of MDR-TB patients are successfully treated, and this form of the disease kills 250,000 people annually.
Work to evaluate shortened treatment regimens for MDR-TB is an important part of the fight against this killer disease. Vital Strategies is proud to be part of work led by The International Union Against Tuberculosis and Lung Disease (The Union) and the Medical Research Council Clinical Trials Unit (MRC CTU) at University College London, who have initiated and led the STREAM Clinical Trial – the world’s first multi-country randomised clinical trial to test the efficacy, safety and economic impact of shortened treatment regimens for MDR-TB.
The Union and the MRC CTU released encouraging news at the 48th Union Conference on Lung Health. Preliminary results from Stage 1 of STREAM show that the nine-month treatment regimen being tested achieved favourable outcomes in almost 80 percent of those treated – very close to the effectiveness of the 20-24 month regimen recommended in the 2011 WHO guidelines, when both regimens are given under trial conditions. The nine-month regimen reduces the pill burden by approximately two-thirds, reduces patients’ costs and helps them get back to work more quickly. In Ethiopia and South Africa, where costs were measured, there was a reduction of at least one-third in costs to the health system for each patient.
Developing and implementing STREAM has been an incredible technical challenge; 424 people across seven sites in Vietnam, Mongolia, South Africa, and Ethiopia are participating in Stage 1. And the same team is screening and recruiting participants across nine sites for STREAM Stage 2, to ascertain whether the regimen can be even more effective.
Vital Strategies’ Research Division is engaged in STREAM and other efforts to combat MDR-TB. Our team provides comprehensive technical assistance – including pharmaceutical management. They also assist the Philippines’ government in the rollout of the shorter regimen as part of the national TB program. They undertake and communicate operational research, including helping stakeholders in Peru to improve the analysis and presentation of TB-related data. They build capacity in low and middle income countries, and support community engagement to facilitate research activities. Community engagement is a key factor in helping to improve recruitment and screening, and communication to support enrolled patients.
TB predominantly impacts those who are economically and reproductively active. It disproportionately impacts low and middle income countries, and the most disadvantaged in society. Tackling this ancient killer is essential to global health and global development. We congratulate our partners in STREAM on the results to date and look forward to progressing this important work. Vital Strategies is proud to play our part.