Tuberculosis and MDR-TB

Since 1920, The Union has been a global leader in the fight against tuberculosis (TB).  From policies for BCG vaccine in the 30s and clinical trials of TB chemotherapy in 50s to the development of DOTS in 80s and the innovative case-finding of FIDELIS in this century, The Union has developed and disseminated the best approaches to TB treatment and control. 

Union projects

In addition to the following specific projects, The Union has had supportive and collaborative relationships with national tuberculosis programmes in Africa, Asia, Latin America and the Middle East since their inception more than 30 years ago.

Download our TB fact sheet or read more about TB.

Childhood Tuberculosis

The Child and Adolescent TB Centre of Excellence

The Union’s Child and Adolescent Tuberculosis (TB) Centre of Excellence is a virtual network of tuberculosis professionals and organisations in the Africa region, providing a community of learning and practice for childhood and adolescent TB. This network, coordinated by The Union’s Uganda Office in collaboration with the United States Center for Disease Control and Prevention offers technical leadership, capacity building and funding opportunities, and promotes collaboration across the region.

Child TB Learning Portal

The Union launched a Childhood TB Learning Portal in March 2015. The Learning Portal is designed to offer a variety of resources aimed at supporting countries’ efforts to address the 10-step plan outlined in The Roadmap for Childhood TB, published in 2013.  The urgent need for training and reference materials on childhood TB for health workers is stressed in this plan. The interactive online course, Childhood TB for Healthcare Workers,  is the first major offering of the Learning Portal.

Read more about child TB

The Union’s largest-ever project: Axshya means “free of TB”

The Union’s Project Axshya, working in partnership with seven sub-recipient partners, a network of local non-governmental organisations (NGOs) and over 15,000 community volunteers, provides innovative tuberculosis (TB) interventions designed to serve traditionally hard-to-reach and at-risk populations in India. Working in tandem with the Revised National TB Control Programme (RNTCP), Project Axshya, meaning TB free, has been able to reach key affected populations, enhance community ownership and create demand for quality services for TB control amongst communities who have the greatest difficulty in accessing TB diagnosis and treatment. For example, Project Axshya volunteers facilitate TB testing in communities where, for reasons including distance, scarce financial resources, health concerns, or family or work commitments, residents would otherwise be unable to reach state clinics and diagnostic centres. The Union’s Project Axshya was launched in April 2010, and is financed by the Global Fund to Fight AIDS, Tuberculosis and Malaria. Read more.

Taking action to prevent a TB–diabetes epidemic

The number of people with diabetes mellitus reached 387 million in 2014, creating a major challenge for health systems around the world, but especially in limited-resource settings.  It also represents a potential challenge for TB control, since this enormous population has a three times greater risk of developing active TB – and also responds less well to treatment.  The Union and WHO developed the Collaborative Framework for Care and Control of Tuberculosis and Diabetes (2011) to provide guidelines for a coordinated response to this public health challenge.

In China and India, two countries with high burdens of both diseases, The Union and its partners have conducted bi-directional screening in public health clinics to identify TB patients with diabetes and vice versa. The results of these pilot projects, funded by the World Diabetes Foundation, led to health officials in India to promote TB-diabetes screening nationwide. Read more.

In 2014, The Union and the World Diabetes Foundation published The Looming Co-epidemic of TB–Diabetes: A Call to Action.

Observational study of a nine-month MDR-TB treatment regimen in Africa

The Union used an operational research approach to test a shortened treatment regimen for multidrug-resistant TB. The final results of this research showed treatment successful for 821 of the 1,006 patients who took part, with 734 cured. The regimen demonstrated similar success rates in HIV-infected patients

The study first demonstrated a greater than 80% success rate in Bangladesh, Cameroon and Niger. It then went on to implementation in nine countries in francophone Africa: Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Côte d’Ivoire, Democratic Republic of Congo, Niger and Rwanda. Read more

TREAT TB Initiative provided fresh perspectives and solutions

The TREAT TB Initiative completed its first five years in September 2013 and received an additional US $8.3 million to continue the STREAM trial in October 2013.  Administered by a North America-based team working with partners around the world, TREAT TB has been funded by the US Agency for International Development (USAID). Recent achievements include:

  • The STREAM clinical trial is currently testing a 9-month MDR-TB treatment regimen modeled on one used in a non-randomised observational study in Bangladesh that demonstrated an 87% cure rate. Protocols for two additiona regimens are going through the approval process. They will be an all-oral 9-month regimen and 6-month regimen. Read more about STREAM.
  • The Operational Research Assistance Project (ORAP) developed with Desmond Tutu TB Centre (DTTC) in South Africa is training new researchers to use OR to identify local solutions to local problems and disseminate their results through publication.
  • Partners in the Diagnostic Tools Initiative have created a computer model that virtually predicts the performance, resource requirements and costs associated with using new TB diagnostic tools in real-world settings.
  • The PROVE-IT study analysed patient records and conducted interviews with patients and health care providers to help determine the efficacy and cost-effectiveness of new TB diagnostic tools.

Read more or download the report: TREAT TB: Description of Research Outputs

Strengthening laboratory networks at all levels

Since 2004 The Union's Laboratory Strengthening Programme has offered technical assistance, provided training and conducted operational research to strengthen national TB laboratory networks and improve their performance.  The programme focuses on improving the quality of AFB microscopy – still the most common method for diagnosing TB  – as well as facilitating the adoption of new techniques and tools, such as LED fluorescent microscopy and Gene Xpert MTB/RIF. Through the WHO/Union Global Project for Surveillance of TB Drug Resistance, The Union also organises proficiency testing for Supra-National and National TB Reference Laboratories. 

The Union was actively involved in preparing Uganda for its accreditation as East Africa’s Supra-National TB Reference Laboratory and played a leading role in the development of the new Global Laboratory Initiative’s Laboratory Diagnosis of Tuberculosis by Sputum Microscopy in 2013. Read more.

Improving access to TB diagnosis and treatment in rural Zimbabwe

The Union Zimbabwe Office in Harare coordinates The Union’s TB CARE activities in that country.  The main objectives have been to improve the sputum transport system and train community treatment supporters to improve access to both TB diagnosis and treatment in 5 rural districts. In addition programmatic management of drug-resistant TB (PMDT) guidelines have been introduced, supported by clinical training, which has increased clinical capacity at provincial levels. Other activities have included health management and finance training, data monitoring and evaluation, and operational research. As a result, the cure rate for confirmed TB cases has improved from a baseline of 63% in 2008 to 76% in June 2011. TB CARE is funded by USAID. Read more.

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