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Developed in 2001, the University of Oxford's T-SPOT test is capable of detecting both latent and active TB infection more rapidly and accurately than the tuberculin skin test (TST). Since its commercial release in 2004, T-SPOT has been adopted by public health agencies for TB control and prevention in the US, UK and Europe. Tuberculosis (TB) is the second leading cause of death from an infectious disease, killing an estimated 1.5 million people worldwide each year. One-third of the approximately 9 million people infected with TB each year are asymptomatic, yet many go on to develop active TB if left untreated.
HIV-1 tuberculosis immune reconstitution inflammatory syndrome (TB-IRIS) is an immune complication of antiretroviral therapy that has vastly increased in frequency in low- and middle-income countries over the last decade. This results from the high tuberculosis rates and the widespread availability of antiretroviral therapy. Mortality from this iatrogenic condition is estimated at 3%. Prior to our work this syndrome was poorly defined and management guidelines anecdotal. We produced the widely accepted and implemented case definition. Imperial also conducted the only randomised controlled trial to date of treatment of this condition. The results are incorporated into international guidelines.
Research by led Dr Andrew Hayward and Dr Alistair Story (UCL Research Department of Infection and Population Health) on tuberculosis in hard-to-reach groups (particularly homeless people, problem drug users and prisoners) has led to the introduction of mobile X-ray screening for tuberculosis in London, screening 8-10,000 homeless people and drug users annually. A pan-London street outreach team has been developed to support hard-to-reach patients with tuberculosis, and social care workers are now a core part of multidisciplinary TB teams. A static digital teleradiology TB screening network has been established in key prisons and, most recently, the research has influenced NICE Public Health Programme Guidelines.
Research carried out by LSHTM has had a major influence on the development of international strategies to screen for tuberculosis (TB) in HIV positive patients. Data from these studies has led directly to new screening algorithms promoted by WHO and other major policy-makers as a key entry point for TB-HIV collaborative activities. Results from these studies have been incorporated into new international guidelines on systematic screening for TB and collaborative TB-HIV activities, resulting in more than 0.5m lives saved and a rapid rise in TB screening for people living with HIV. A companion case study addresses impact on use of isoniazid preventive therapy.
Edinburgh research has played a central role in the development of Tuberculosis (TB) control policy in South Asia in general, and in Nepal in particular, with specific impact in placing patient- centred approaches at the heart of health policy. This has taken the following main forms:
In 2006, new diagnostic tools for tuberculosis (TB) were introduced through the NICE guidelines, assuming they would perform equally well in adults and children. Research conducted by Imperial College researchers proved this assumption to be incorrect and that TB diagnostics needed to be evaluated specifically for children, as performance was different from adults. The Imperial researchers were the first to conduct the evaluations. Their results subsequently influenced the use of diagnostics and overall management of childhood TB, including the design of a public health tool for contact tracing in the community and inclusion of their results and recommendations in national and international guidelines.
Leeds research has led to adoption of effective, patient-friendly tuberculosis (TB) care delivery in Nepal and Pakistan, relaxing the global TB treatment strategy's requirement that (generally very poor) patients attend a health centre every day for 2 months for supervision and support that led to unemployment, poverty and debt. This impact has reach across the more than 300,000 people a year treated for TB in Nepal and Pakistan; and its significance is that patients can retain their usual employment yet still have a high likelihood of cure. Our research demonstrated that home-based care was feasible under routine low-income country TB programme conditions, was as effective as health centre-based care, and was much more acceptable than health centre-based care.
In 2010, 8,483 cases of tuberculosis (TB) were reported in the UK, mainly in urban areas and with London and the West Midlands having the highest rates of disease (rate within Heartlands Primary Care Trust 80+ per 100,000). Research led by Professor Peter Hawkey at the University of Birmingham has resulted in the development of novel techniques for real time typing of Mycobacterium tuberculosis strains. The new cost effective and rapid methodology has been adopted by the three UK national reference laboratories and has resulted in significant improvements to the national TB typing scheme and TB infection management. An associated secure IT system has been developed to enable TB control teams to rapidly receive typing data together with an analysis of the local cases. This has influenced changes in clinical practice by reducing the need for contact tracing. Use of the new techniques developed at Birmingham has resulted in faster, more accurate identification of outbreaks of TB and this information has been used to significantly improve patient management.
Researchers at the Oxford University Clinical Research Unit (OUCRU) in Vietnam demonstrated the effectiveness of dexamethasone (a corticosteroid) as an adjuvant treatment for Tuberculous Meningitis (TB meningitis). OUCRU's research persuaded the World Health Organization (WHO) to recommend corticosteroid therapy for the treatment of TB meningitis, and this has been shown to reduce the mortality and long-term disability caused by this devastating disease by 30%.
LSHTM research has resulted in isoniazid preventive therapy (IPT) becoming one of the key interventions recommended by WHO to reduce the impact of tuberculosis (TB) among HIV-positive people. As a direct result of the research findings, WHO recommendations now promote wider use of IPT. In addition, barriers to implementation have been overcome, leading to increasing worldwide use of IPT for TB prevention among people with HIV. A companion case study addresses impact on screening for TB amongst such people.