New global commitment to end tuberculosis requires research support

TDR news item
28 November 2017

Urgent action to end tuberculosis (TB) by 2030 has been agreed at the first WHO Global Ministerial Conference on Ending Tuberculosis in Moscow. The conference, opened by President Vladimir Putin of the Russian Federation together with Amina J Mohammed, UN Deputy Secretary General, and Dr Tedros Adhanom Ghebreyesus, WHO Director-General, brought together delegates from 114 countries.

"Today marks a critical landmark in the fight to end TB,” said Dr Tedros. “It signals a long overdue global commitment to stop the death and suffering caused by this ancient killer."

The Moscow Declaration to End TB is a promise to increase multisectoral action as well as track progress, and build accountability. It will also inform the first UN General Assembly High-Level Meeting on TB in 2018, which will seek further commitments from heads of state.

Global efforts to combat TB have saved an estimated 53 million lives since 2000 and reduced the TB mortality rate by 37%. However, progress in many countries has stalled, global targets are off-track, and persistent gaps remain in TB care and prevention.

As a result, TB still kills more people than any other infectious disease. There are major problems associated with antimicrobial resistance, and it is the leading killer of people with HIV.

More than 1000 participants took part in the two-day conference which resulted in collective commitment to ramp up action on four fronts:

  • Move rapidly to achieve universal health coverage by strengthening health systems and improving access to people-centered TB prevention and care, ensuring no one is left behind.
  • Mobilize sufficient and sustainable financing through increased domestic and international investments to close gaps in implementation and research.
  • Advance research and development of new tools to diagnose, treat, and prevent TB.
  • Build accountability through a framework to track and review progress on ending TB, including multisectoral approaches.

Ministers also promised to minimize the risk and spread of drug resistance and do more to engage people and communities affected by, and at risk of, TB.

TDR efforts on tuberculosis

TDR works closely with WHO and many other partners in a number of key areas to build research capacity and identify new approaches. Below is a list of some activities that are either focused on tuberculosis specifically, or in combination with other diseases.

SORT IT operational research and training: Public health programmes in low- and middle-income countries, working with WHO, identify their challenges or bottlenecks on specific issues. TDR supports national public health workers to be trained to use their country’s own data to conduct research that can lead to local health system improvements. Participants work on topics such as multidrug-resistant tuberculosis, malaria, neglected tropical diseases, maternal and child health, HIV and non-communicable diseases.

Implementation research training: TDR provides a continuum of training materials on implementation research, including an online toolkit that has been named one of the top ten community engagement tools. Implementation research is the systematic approach to understanding and addressing barriers to effective and quality implementation of health interventions, strategies and policies. It is demand-driven, with research questions framed on the basis of needs identified by relevant stakeholders/implementers working together in the health system.

Access and Delivery Partnership: TDR is part of a broad, multi-partner effort to strengthen capacity in low- and middle-income countries that improves access to and delivery of new health technologies. These technologies include drugs, diagnostic tools and vaccines that are relevant for the prevention, treatment or cure of tuberculosis, malaria and neglected tropical diseases.

Innovative training builds capacity for stronger drug safety monitoring: A new health worker training model in Nigeria, adapted from a global research and capacity-building initiative, has been shown to increase reporting of adverse drug reactions (ADRs) in a country treating the largest population of people living with HIV/AIDS, tuberculosis (TB) and malaria.

Special collection of articles on neglected infectious diseases in Myanmar: The journal Infectious Diseases of Poverty is issuing a special collection of operational research articles seeking evidence-based solutions for improving the performance of national programmes for neglected infectious diseases in Myanmar. Five papers, focused on malaria and tuberculosis (TB) control, have been published to date.

West African Regional Network for Tuberculosis control: TDR has initiated the West African Regional Network for Tuberculosis (WARN-TB). In line with the End-TB Strategy, the focus is on developing more effective approaches to TB care, using implementation and operational research to investigate barriers and design new solutions for individual countries and the entire sub-region.

TB active drug safety monitoring: The World Health Organization global database for the surveillance of adverse events in the scope of active drug safety monitoring and management of anti-tuberculosis drugs (WHO Global aDSM Database) is a collaborative initiative to generate reliable evidence on the safety profile of anti-tuberculosis drugs to inform future tuberculosis treatment guidelines. It was developed and is managed by the WHO Global TB Programme (GTB) and TDR. The goal is to facilitate pooling of safety data issued from local or national databases in the context of TB active drug safety monitoring and management (aDSM) and support early detection of any potential safety signals.

Clinical research and development fellowships: This one-year programme is designed for scientists from developing countries to work with pharmaceutical and research institute partners to learn how to lead clinical drug and vaccine trials. The ultimate goal is to reduce research bottlenecks as more new products enter the development pipeline, and develop strong research capability in low- and-middle income countries with infectious diseases.

For more information, please contact: Piero Olliaro.