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Chapter 1: What is the history and current state of tuberculosis?
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You can't just treat a person with that disease as if it's like you just got a bug that you're treating. You're treating a person who has a whole lot of other things going on with them. And you've got to understand how those work together.
Welcome to When Science Finds a Way, a podcast about the science changing the world. I'm Alicia Wainwright, and on this series, I'm talking to the global experts who are making a difference, as well as the people who have inspired and contributed to their work. This episode is about ending the world's deadliest infectious disease, tuberculosis, or TB. TB is contagious and airborne.
In 2024, 10 million people were diagnosed with TB, and it caused over a million deaths. TB is preventable and curable with the right treatment. But this is complicated by the emergence of drug-resistant strains of the disease. These strains are not susceptible to the usual frontline treatment and require special diagnostic tests and drug regimens.
And this is a challenge because the TB burden falls disproportionately on settings and populations in which these resources may not be easily accessible. Joining me to discuss TV is Professor Salome Charlombus, Group Chief Health Officer at the Orem Institute in South Africa.
Salome has been in this field for years, and the organization is involved in research, clinical trials, policy, and frontline health services for infectious disease in the country. So let me describe the scale of the challenge of drug-resistant TB and the funding gap for prevention, diagnosis, treatment, and care.
But there's also hope here with so much progress that's already been made and some breakthroughs on the horizon. So let's give a general definition of tuberculosis. What is it and how does it spread?
So TB is caused by a germ, the germ we call mycobacterium tuberculosis. And it really is spread when people breathe in droplets that have got TB in them. Basically, what happens to a lot of us that live in a country with high rates of TB, including myself and especially healthcare workers, is that we breathe in these droplets very young, so as children.
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Chapter 2: How does drug-resistant TB impact treatment options?
So again, up until about... 10 years ago, the way that we diagnosed TB was the same as in the 1950s. So we were using a microscope and diagnosing TB on sputum under a microscope. And luckily, there have been new diagnostic tests that have now come out that are better than that. And they have been rolled out in most parts of the world. But it's It's been quite an expensive test.
And so we're still finding that only about 60% of all people who are diagnosed with TB are being diagnosed with the right test. And part of the reason is because of the cost of the test and the difficulties with getting those tests into the poorer countries, which are the countries that have TB.
But more recently and very, very recently, we're actually expecting WHO to come out with a guideline for a brand new test that has just been found that has been a lot cheaper than the previous test. And we are hoping that that will improve the diagnosis. And how we diagnose TB is through sputum. So people cough and then that's sputum. So it sounds horrible. That gets tested for TB.
Got it. So it's not just spit. It's almost like...
phlegm right is that kind of the better way to say that we call it sputum but yes it's phlegm basically but this new test that has just come out is actually using a lot of the technology that came out of COVID and it's actually using a mouth swab so do you remember when we used to have the nasal swabs for COVID it's actually using a mouth swab And it's able to do the test in clinics.
So it doesn't require a laboratory infrastructure for the test. And so everyone's very excited about this. But like I say, WHO hasn't actually even released the guideline yet around that. But everyone's getting very excited and the test is being produced and lots of plans are underway to actually start rolling out that test in many different countries. So currently, how is TB typically treated?
Unfortunately, a regimen that has up to four drugs and is taken for as long as six months and has many side effects. So we don't have the best treatment for TB. And much of that is because there was a period where TB rates were dropping drastically in the whole world. And then unfortunately, when HIV arrived... There was a resurgence of TB.
And so then with this resurgence, there's been a lot of work now to try and find new drugs. But the emphasis has really been on drugs for those people who are resistant to what we call the first line drugs, which is the first lot of drugs. And these are pills? Yes. Yes, they're pills. Yes. Yeah. And a daily medication for six months.
And many of the drugs that we use, unfortunately, do have side effects. So people will often tell you about, you know, that they really feel very ill while taking TB treatment because of the the many side effects of TB treatment. So it's really something where we are hoping for newer and better regimens and we're wanting to see that happen.
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Chapter 3: What are the challenges in diagnosing drug-resistant TB?
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