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PS-005
POLICY-DRIVEN INTERVENTIONS: TUBERCULOSIS
  1. Gerhard Walzl1,
  2. Novel Chegou1,
  3. Stephanus Malherbe1,
  4. Mark Hatherill2,
  5. Thomas J. Scriba3,
  6. Daniel E. Zak4,
  7. Clifton E. Barry III5,
  8. Stefan H.E. Kaufmann6
  1. 1DST/NRF Centre of Excellence for Biomedical TB Research and MRC Centre for TB Research, Division of Molecular Biology and Human Genetics, Stellenbosch University, Tygerberg, South Africa
  2. 2South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine & Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
  3. 3South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine & Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
  4. 4The Center for Infectious Disease Research, Seattle (WA) USA
  5. 5Tuberculosis Research Section, Laboratory of Clinical Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (MD) USA
  6. 6Department of Immunology, Max Planck Institute for Infection Biology, Berlin, Germany.

Abstract

Annual tuberculosis (Tb) rates decline by 1.7%, which is inadequate to reach WHO targets. We describe three host-biomarker developments that are entering clinical testing and that could accelerate progress against TB.

Blood mRNA signatures with promising predictive ability for incident TB were recently described in African cohorts. Correlate of risk (COR) positive participants have 7 to 18 times increased risk for progression. A clinical trial is underway in South Africa under leadership of the South African Tuberculosis Vaccine Initiative to evaluate targeted chemoprophylaxis in COR positive people in an area with a very high prevalence of latent TB infection, where untargeted preventative treatment is not practical.

Historical data suggests that 85% of patients are cured after 4 months of TB treatment but attempts to shorten treatment without an unacceptable relapse rate have failed. Treatment shortening criteria based on PET/CT imaging and microbiological criteria were developed. An EDCTP/Bill & Melinda Gates Foundation/NIH co-funded study, led by the Tuberculosis Research Section of the NIH, will start in South Africa and in China in 2017 to evaluate biomarker-driven treatment shortening to 4 months.

To address diagnostic bottlenecks, a blood-based 7-host marker diagnostic signature was recently found with promising screening potential for active TB. An EDCTP-funded project with Africa and EU partners aims to develop a point-of-care, finger stick blood test that can simultaneously measure all 7 markers and rule out 75% of people with symptoms compatible of active TB in whom the diagnosis is subsequently ruled out. Such screening tests could speed up diagnostic work-up and save significant costs. Taken together, biomarker-driven interventions are now being actively tested and hold promise to provide important tools towards the eventual eradication of the TB scourge.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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