Tuberculosis update 2018 from A/Prof Anna Ralph

Guest posting: Associate Professor Anna Ralph, Director of Global and Tropical Health at Menzies School of Health Research, Darwin, Northern Territory, Australia.

News : UN General Assembly first ever High-Level Meeting on the fight against tuberculosis, September 28th 2018.

New(ish) WHO strategy and targets:

	SDGs	End TB Strategy
Reduction in number of deaths vs 2015	90%	95%
Reduction in TB incidence vs 2015	80%	90%
TB-affected families facing catastrophic costs	0%	0%

New terminology

Active TB = TB disease
Latent TB = TB infection

New treatment approaches

TB disease:
- Rifampicin dosing ≥20mg/kg
- MDR-TB: WHO Landmark announcement 17 August 2018
- Revised grouping of drugs – see page 2
- all oral bedaquiline-based regimen – based on : in which death rate was halved in those receiving bedaquiline compared with other MDR/XDR regimens (retrospective register study, South Africa)
- Subgroups who might be able to avoid prolonged injectables: children with lesser-burden disease.
TB infection:
- New WHO 2018 guideline
- Progressive shortening of regimens for TB infection for DS-TB contacts: can we get away with 1 month? 1HP vs 9H
- For MDR-TB contacts:
- V-QUINN study – levofloxacin vs placebo, contacts aged >15: still enrolling
- PHOENIx study – delaminid vs INH, all ages: still enrolling
- Example of high-burden national policy (Indonesia): levofloxacin plus ethambutol

What’s old but still interesting:

TB incubation period (from exposure until active TB) = 3-36 months (depending on age and immune status) ; therefore get in early with IPT, especially in infants
IPT number needed to treat = 35 ; but number needed to treat for contact management and investigation more like 20 since management and investigation detects co-prevalent disease, which can occur in up to 10% of household members depending on the setting: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3840405/

What’s new through a human rights lens

MDR-TB drugs – Old WHO grouping (WHO 2010)