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. Download our TB fact sheet or read more about TB.

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.

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

SPARK-TB, a valuable and innovative model for diagnosing and treating TB

The SPARK-TB (Slum Partnerships to Actively Respond to Tuberculosis in Kampala) project implemented in Uganda through the support of the Stop TB Partnership initiative TB REACH, provided a valuable and innovative model for diagnosing and treating TB that takes into account the social and economic factors that promote its spread in low-income, urban areas. The programme was successful enough that with additional support from TB REACH, it was expanded to 12 other major urban areas in Uganda, and was incorporated into the national strategy. The project concluded in 2014. Read more

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

Project Axshya is a 5-year civil society initiative to strengthen TB care and control in India. With the largest TB burden in the world, India has recognised that the excellent work of its Revised National TB Control Programme must be augmented by stakeholders from all sectors of society, if all who need TB services are to be reached.  The Union’s largest-ever project, Axshya is coordinated by a team based at The Union South-East Asia Office, who work with 9 sub-recipient partners.  Launched in April 2010, the project has now reached 300 districts in 21 states, and it involves 1,200 NGOs, 3,000 civil society organisations and 21,000 rural healthcare providers who bring TB information and services to 750 million marginalised people. Project Axshya is funded by a Round 9 grant from the Global Fund to Fight AIDS, TB and Malaria (The Global Fund). 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.

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.

The Global Health Bureau, Office of Health, Infectious Disease and Nutrition (HIDN), US Agency for International Development financially supported the development of this project through TB CARE I.

Read more about Child TB

Childhood TB online course

The Union launched an interactive online course, Childhood TB for Healthcare Workers, in collaboration with the World Health Organization (WHO) in March 2015. The six-module curriculum covers how to diagnose, treat and prevent childhood TB, including how to perform contact screening. The modules are interactive and ask participants to make decisions about patient care in various settings through case examples. 

The self-paced course, which takes six to eight hours to complete, is designed for healthcare workers at the secondary and primary level of the healthcare system. The content is based on the WHO’s 2014 Guidance for national tuberculosis programmes on the management of tuberculosis in children, as well as The Union's Desk guide for diagnosis and management of TB in children, and focuses on the clinical management of childhood TB. One full module is dedicated to TB prevention, focusing on household contact screening and provision of preventive therapy.

For more details or to register for the course

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.

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.

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