Highlights

Big Steps Against a Leading Killer

Our multidisciplinary groups are tackling tuberculosis (TB) by focusing on those most at risk: children, adults with HIV, incarcerated populations, and people living in extreme poverty

Our multidisciplinary groups are tackling tuberculosis (TB) by focusing on those most at risk: children, adults with HIV, incarcerated populations, and people living in extreme poverty

Tuberculosis

2023

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deaths
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In 2023, TB reclaimed its place as the world’s leading infectious killer, surpassing COVID-19 after a three-year hiatus. According to the WHO, 1.25 million people died from TB and an estimated 10.8 million people fell ill. This is particularly tragic because TB is both preventable and curable.

A series of studies by ISGlobal researchers could help turn the tide by improving TB diagnosis in children and adults with HIV, assessing its burden in prisoners, and demonstrating the impact of poverty-reduction programmes.

Use stool to improve diagnosis

Tuberculosis diagnosis typically relies on sputum samples, but these are difficult to obtain from children and adults with HIV—two of the groups most at risk. Alberto Garcia-Basteiro and his team, as part of the Stool4TB partnership, showed that stool samples can be successfully used to detect M. tuberculosis DNA with the molecular Xpert/Ultra test. In children, adding stool tests increased case detection by 39%, according to a meta-analysis of 35 independent studies. In adults with HIV, it improved TB diagnosis, especially in those with severe immunodeficiency.

Stool Xpert/Ultra offers an easier and effective way to confirm TB, especially when respiratory samples are difficult to obtain,

– Lucía Carratalá, first author of the study.

Focus on prisoners

Prisons are high-risk environments for TB transmission, yet this problem is often overlooked. In a study involving nearly 3,000 inmates from five prisons in Paraguay, Guillermo Sequera (PhD student under Garcia-Basteiro’s supervision) and colleagues found that the risk of contracting TB nearly doubles after six months of incarceration, increases with every year spent in prison, and, even after release, former inmates are 10 times more likely to develop TB compared to the rest of the community. This means that effective control interventions in prisons, such as reducing overcrowding, could significantly lower TB rates at the national level.

Reduce poverty

But the most powerful way to prevent TB is to tackle poverty itself, as shown by Davide Rasella and his team. Analysing data from over 54 million people in Brazil, they show that Brazil’s Bolsa Familia Program, which provides financial support to the poorest families since 2004, was linked to a large decrease in TB cases and deaths – over 50% among extremely poor people and more than 60% in indigenous populations.

The message is clear: social protection programmes not only reduce poverty and malnutrition, but are also vital for achieving global TB targets,

– Davide Rasella.

Use a common language

Effective TB control requires communication across disciplines and sectors. ISGlobal and McGill University brought together policymakers, funders, researchers and TB patients to create the Global TB dictionary, an open-access resource that provides standardised terminology and will be regularly updated.

This is a step forward towards improving collaboration and coherence in TB research and control,

– Alberto García-Basteiro.

We hope that this dictionary will be useful for the overall TB field, including scientists, health professionals, public health officers and affected communities,

– Joanna Ehrlich, the project manager.

References

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