TB kills 1.8 million people every year. We have been treating TB patients for over 30 years.

Tuberculosis (TB) is a deadly infectious diseases. 

Each year TB kills 1.8 million people with nearly another nine million suffering from the disease, mainly in developing countries.

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TB is the major killer of people living with HIV in Africa. Almost half a million people develop multi drug-resistant strains of the disease every year.

TB is often thought of as a disease of the past but a recent resurgence and the spread of drug-resistant forms makes it very much an issue of the present day and age. Today, TB is one of the three main killer infectious diseases, along with malaria and HIV/AIDS.

Though the global death rate from TB dropped more than 40 percent in in the years between 1990 and 2011, there are still crucial gaps in coverage and severe shortcomings when it comes to diagnostics and care options.

Furthermore, we are currently seeing an alarming rise in cases of drug-resistant and multidrug-resistant tuberculosis (DR-TB and MDR-TB) that do not respond to the customary first-line drugs.

MSF has been fighting TB for over 30 years. We provide treatment for the disease in many different contexts, from chronic conflict situations, such as Sudan, to vulnerable patients in stable settings such as Uzbekistan and the Russian Federation.

Hover over the image below for an interactive guide to TB

What causes TB?

TB caused by a bacterium (Mycobacterium tuberculosis) that is spread through the air when infected people cough or sneeze.

The disease most often affects the lungs but it can infect any part of the body, including the bones and the nervous system.

Most people who are exposed to TB never develop symptoms, since the bacteria can live in an inactive form in the body, but if the immune system weakens, such as in malnourished people, people with HIV or the elderly, TB bacteria can become active.

Around 10 percent of people infected with TB will develop active TB and become contagious at some point in their lives.

Symptoms of TB

Symptoms include a persistent cough, fever, weight loss, chest pain and breathlessness in the lead up to death. TB incidence is much higher and is a leading cause of death among people with HIV.

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Diagnosing TB

The research and development (R&D) of new, more effective diagnostic tools and drugs for TB have been severely lacking for decades.

In countries where the disease is most prevalent, diagnosis has depended largely on one archaic test for the last 120 years – smear microscopy, the microscopic examination of sputum, or lung fluid, for the TB bacilli.

The test is only accurate half of the time, even less so for patients who also have HIV.

This means that too many patients start treatment late, if they start it at all.

Children, who often cannot produce sputum, urgently need a new diagnostic tool, especially since they are particularly vulnerable to dying if they develop active TB.

A promising new diagnostic test, Xpert MTB/RIF, was introduced in 2010 and MSF has used it in many of its programmes since. It’s not applicable to all settings, nor is it effective for diagnosing children or patients with TB that occurs outside of the lungs (extra-pulmonary TB), so MSF continues to call for further R&D in diagnostics for TB.

Listen to British doctor Emily Wise discuss her time treating TB in Uzbekistan on the MSF podcast, Everyday Emergency

Treating TB

A course of treatment for uncomplicated TB takes a minimum of six months. When patients are resistant to the two most powerful first-line antibiotics (rifampicin and isoniazid), they are considered to have MDR-TB.

MDR-TB is not impossible to treat, but the drug regime is arduous, taking up to two years and causing many side effects. XDR-TB is identified when resistance to second-line drugs develops on top of MDR-TB. The treatments for XDR-TB are limited.

In many places where we work, supervising all TB patients during their treatment is difficult to impossible. So, to help patients complete their treatment, MSF has introduced more flexible strategies.

MSF activities 

MSF has been fighting TB for over 30 years. We provide treatment for the disease in many different contexts, from chronic conflict situations, such as Sudan, to vulnerable patients in stable settings such as Uzbekistan, southern Africa and the Russian Federation.

MSF has TB treatment projects in 24 countries around the world and, in 2016, started 20,900 patients on treatment, including 2,700 patients with MDR-TB. Two new drugs – bedaquiline and delamanid – have recently become available to some patients who have no other treatment options left. MSF and other treatment providers are showing that stronger TB regimens containing one of the new TB drugs along with ‘repurposed’ drugs (not specifically developed for TB but that have shown efficacy in treating it) can significantly improve the health of people with MDR-TB.

As of August 2017,  MSF has initiated around 1,500 patients on bedaquiline and/or delamanid in 12 countries. Programmatic data has shown promising early results on the effectiveness of these regimens, while patients report that the toxic side effects of treatment are reduced. It is also hoped that using the two new drugs in combination will be particularly effective in treating patients with the most severe forms of drug-resistant TB. In MSF projects in Armenia, Belarus, India, Mozambique, South Africa, and Swaziland, medical teams are already piloting the combination of the two new drugs as part of the regimen for patients with very limited treatment options.

MSF is involved in two TB clinical trials – TB PRACTECAL and as part of the endTB partnership – to find new, shorter, more effective combination treatments for multi-drug resistant TB that include the new drugs. Patients’ needs are at the heart of both trials, which aim to find treatments that contain no injectable drugs and have manageable side effects. Both trials had enrolled their first patients by the end of March 2017.

Globally, there is still an unacceptable gap between those who would benefit from these new drugs and those who are able to access them. As of August 2017, only an estimated five per cent of patients eligible for treatment with the drugs have been able to access them globally through programmatic use (i.e.outside clinical trials) or compassionate use, the majority of them in South Africa. There is an urgent need to increase people’s access to these more effective treatments by making them affordable and available.

Access to appropriate diagnostic tools for detecting TB must also be prioritised, including developing affordable rapid tests that deliver results on the spot. The most widely-used test for diagnosing active TB in developing countries relies on examining a patient’s phlegm under a microscope, known as microscopy. This method, developed nearly 140 years ago, detects less than half of all active TB cases and largely fails to detect the disease in children, people co-infected with HIV and those with drug-resistant forms of TB. Other diagnostic methods exist, but most require laboratories, a steady power supply and, like microscopy, skilled staff to deliver results – all of which are mainly unavailable in remote and rural settings. Diagnostic tests that can determine if patients are resistant to standard TB treatments are also needed.

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