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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.
This case study describes the impact on national and global tuberculosis (TB) control policy of research led by Cuevas, Squire and Theobald at the Liverpool School of Tropical Medicine (LSTM). Early research led to the publication of the World Health Organisation (WHO) Options for National TB Control Programmes `Addressing the Poverty in TB control' in 2005. Further research led to WHO endorsement of same-day diagnosis of TB by smear microscopy (SM) in 2010. This strategy has been implemented in Malawi, Nigeria, Yemen, Ethiopia and Nepal. Alongside this we have developed and tested approaches to bring diagnosis and treatment for TB closer to the community. Same-day diagnosis and close-to-community approaches have led to improvements in access to TB care and treatment, and reductions in costs incurred during care-seeking by poor patients in these countries and elsewhere.
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.
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.
There are 10 million new infections and one million deaths from tuberculosis annually and there is an increase in resistant diseases. Yet there have been no new anti-tuberculosis agents developed for forty years. TB drug development is expensive because of the time taken for the organism to grow and because trials are expensive and the sample size is high. The biomarker and mathematical methods developed at St Andrews address these problems by making preclinical development faster and cheaper and is being used by three commercial companies and eight drug development groups. These methodologies shorten the time taken to complete trials and reduce cost.
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.
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:
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.
This research has profoundly influenced the practice of pharmacoepidemiology in 2008-13. The self-controlled case series (SCCS) method is particularly well-suited for working with computerised databases, which are increasingly used in epidemiology. The method has been recommended by international agencies (WHO, ECDC) and is now widely used by health practitioners within national public health agencies, including the CDC (USA), Public Health England (UK) and many other national and regional public health bodies. It has influenced practice within the private sector (notably the pharmaceutical and the healthcare industries). Use of the SCCS method has impacted on health by reducing costs, improving timeliness and improving the quality of evidence upon which policy decisions are based.
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.