World TB Day 2012: Strengthening tuberculosis research in Africa
On the occasion of World Tuberculosis (TB) Day, 24 March 2012, the European and Developing Countries Clinical Trials Partnership (EDCTP) has published a short video that highlights some of the EDCTP funded TB research in sub-Saharan Africa. Four major concerns drive tuberculosis research. The standard method of diagnosing the disease has low sensitivity among HIV co-infected patients. Diagnosis is a lengthy process which delays intervention, thereby increasing the risk of disease transmission, and making monitoring of drug resistance more difficult. The six month standard treatment of the disease takes too long which places a heavy burden of adherence on patients and increases the risk of the development of drug-resistant strains of the bacteria. HIV co-infection does not just increase TB caseload but makes combined treatment of both diseases difficult. Options for the prevention of TB are limited as the current vaccine does not protect adults from developing tuberculosis. EDCTP-funded research targets these three areas of diagnostics, treatment, and prevention of TB.
New diagnostics: biomarkers in the AE-TBC
The goal of the African-European Tuberculosis Consortium (AE-TBC) is to develop new, sensitive, inexpensive and field friendly TB diagnostic tests. The consortium aims to recruit 800 HIV negative and 400 HIV positive adults with suspected TB to evaluate the ability of a 3-marker test to identify active disease. Such a multi-marker test can be developed into rapid, point-of-care tests using lateral flow technology. A sample bank for future diagnostic studies will be established. AE-TBC is composed of seven African institutions and five European institutions. Through this project, clinical trial capacity at the participating sites will be built, and networking in the field of TB diagnostic research will be improved.
Shorter treatment: The Pan African Consortium for Evaluation of Antituberculosis Antibiotics
The current standard TB treatment takes six months to complete, resulting in a high rate of defaulters and treatment failures. The Pan African Consortium for the Evaluation of Antituberculosis Antibiotics (PanACEA) explores new drugs that have the potential to shorten TB treatment. The consortium was formed to conduct a series of cooperative clinical trials to evaluate three different drugs (Moxifloxacin, Rifampicin and SQ109) for the treatment of drug-sensitive tuberculosis to simplify and shorten the current regimens. Through this project, PanACEA aims to conduct clinical trials in conformity to regulatory standards, and to establish the required registration-quality clinical trial capacity at 11 sites in sub-Saharan Africa. The consortium will also develop an enduring framework for the current and future clinical trials for TB drugs.
Safe treatment combinations in TB-HIV co-infected patients: Rifabutin and HAART
The clinical management of tuberculosis and HIV co-infection cases is made difficult by several factors, including important interactions between the rifamycins (rifampin and rifabutin) and the antiretroviral drugs in the class of protease inhibitors (PI). This senior fellowship project by Dr Seni Kouanda aims to determine the pharmacokinetics parameters of rifabutin in combination with Lopinavir/ritonavir in Burkina Faso among HIV-infected patients with tuberculosis, in order to define optimal doses that will inform future larger phase III trial comparing safety, tolerability and efficacy of combined treatment regimens.
Prevention: the MVA85A candidate vaccine against TB
MVA85A is one of the leading new TB vaccines. EDCTP funds a phase IIb, randomised controlled clinical trial which aims to evaluate the protective efficacy of a booster MVA85A vaccination administered to HIV-infected subjects in South Africa, Senegal and The Gambia by comparing the incidence of TB disease and infection in a vaccinated and control group. The capacity building component of the project will develop the trial sites in Dakar, Senegal and Cape Town, South Africa to enable them to participate in similar clinical trials in the future.
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