Towards a world free of tuberculosis: The ADVANCE-TB COST Action

Tuberculosis (TB) is caused by Mycobacterium tuberculosis. For decades, it has been among the top 10 reasons of death globally, and the number one infectious killer. Furthermore, it is still associated with significant stigma in the eyes of the public. TB generally affects the lungs, but it can also affect other organs. Most infections do not progress to active disease with symptoms, in which case it is known as latent TB (LTBI). It is estimated that 1.7 billion individuals (23% of the world's population) have LTBI.

During the SARS-CoV-2 pandemic, COVID-19 briefly overtook the leading role among infectious killers, diminishing attention to TB. Moreover, global TB control was unfortunately neglected and, according to the World Health Organization, tuberculosis mortality increased for the first time in over 10 years from 1.4 million deaths in 2019 to 1.6 million deaths in 2021. According to the recently released World Health Organization TB Report 10.6 million people fell ill with TB in 2022 with 1.3 million deaths and 410.000 new multidrug-resistant TB cases diagnosed.

Despite global commitments to end TB by 2030, the epidemic shows no signs of slowing down. Earlier this year, the UN General Assembly organized a high-level meeting on the fight against tuberculosis. Furthermore, the UN announced the creation of the TB Vaccine Accelerator Council at the World Economic Forum in Davos, to speed up the licensing and use of effective novel vaccines against TB.

Current challenges

Tuberculosis is a curable and preventable disease. However, to successfully control TB we need better diagnostic tools, more effective therapy (especially for drug-resistant TB), and a new vaccine.

The only licensed TB vaccine used worldwide is The Bacillus Calmette-Guérin (BCG) vaccine developed a century ago. It does not ensure lifelong protection but it does protect from severe TB forms during childhood. Several vaccine candidates are in clinical trials, aiming at either protection from TB infection or limiting the progression from LTBI to active TB, but a long road still lies ahead. TB Vaccine Pipeline currently provides information on vaccine candidates in clinical development.

A major challenge for TB control is that there is currently no test or biomarker able to identify the 5 -15% of infected individuals who have an increased risk to at any point in their lifetime progress from LTBI to active TB disease. Further studies for the characterisation, understanding, and identification of patients with a higher risk of disease progression are needed, especially in vulnerable populations (i.e. children, and HIV patients). It is important to identify and treat infected individuals early as LTBI cases can become active cases and thus be infectious to others, facilitating dissemination and transmission.

Tuberculosis is curable when treated with the correct antibiotics for the correct period of time. However, in some cases, TB bacteria develop resistance and do not respond to the standard drugs. This results in longer treatment periods often accompanied by undesirable side effects and poorer outcomes. Moreover, the cost of treating a patient with drug-resistant TB is significantly higher than treating one with pan-susceptible TB.

Furthermore, TB is often associated with stigmatization, and socio-economic determinants play an important role in the course and severity of the disease. This highlights the importance of identifying individuals with specific risk factors to improve prevention and disease control strategies.

The main challenge, here, is how to improve the management, diagnostics, and treatment of patients with TB by better integrating clinical knowledge and research. Our project tries to address these challenges by facilitating and encouraging collaboration between key players such as hospitals, NGOs, academic institutions, and small/medium enterprises through a structured, coordinated, and open European research network.

Introducing ADVANCE-TB

Launched in September 2022, the ADVANCE-TB COST Action aims to address the complexity of TB management. ADVANCE-TB is a research network that offers opportunities for collaboration between clinicians, academic researchers from interdisciplinary backgrounds, industry, and non-governmental organisations to advance the global control of TB.

The network has more than 134 members coming from 42 different countries worldwide and keeps growing. Innovators will be connected to clinical research sites in different settings to plan and implement emerging approaches for TB management, and to tackle the stigma perceived by the public.

"Our Action brings together researchers from interdisciplinary backgrounds to improve tuberculosis management. The network has members affiliated with clinical sites, research institutions, academia, small and medium enterprises, and non-governmental organizations distributed around the globe, and our efforts are devoted to combat TB from different perspectives." Dr Alicia Lacoma, Chair of ADVANCE-TB

Tuberculosis: curable and preventable

ADVANCE-TB will enable a detailed review of tuberculosis by country, highlighting bottlenecks and differences in management.

The network is also working to find better ways to prevent, diagnose, and effectively treat TB. In addition, they will help visualise the stigma regarding the disease, and the impact that TB has on patients and their families. To end TB, we need a multi-sectoral approach involving not only the general health sector but also stakeholders and advocacy groups, among others. "With ADVANCE-TB we hope to take action and move forward in this direction" adds Dr Alicia Lacoma, Chair of the network.

Looking ahead

"After four years, the tasks developed within our network will provide scientific evidence on how multifaceted aspects of TB could be improved, while increasing its awareness. The multidisciplinary background of the members as well as the diverse profiles of the participating institutions is invaluable to achieve such an objective." explains Alicia. "In addition, the network will secure its consolidation by participating in forthcoming international call applications in the TB field."

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