Tuberculosis Global Challenges and Modern Solutions

Jadish Newer^*
*Correspondence: Jadish Newer, Department of Biochemistry, School of Medicine, University of Medical Sciences, Tehran, Iran, Email:

Introduction

Tuberculosis (TB) caused by the bacterium Mycobacterium tuberculosis, is one of the deadliest infectious diseases globally. Despite being curable and preventable, TB remains a leading cause of death, particularly in resource-limited settings. The World Health Organization (WHO) estimates that in 2022, TB caused approximately 1.5 million deaths and affected 10 million people worldwide. This article delves into the global challenges posed by TB and explores modern solutions aimed at mitigating its impact. One of the most pressing challenges in TB control is the emergence of drug-resistant strains. Multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) complicate treatment efforts and increase mortality rates. MDR-TB is resistant to at least isoniazid and rifampicin, the two most potent TB drugs, while XDR-TB is resistant to these drugs and additional second-line drugs. The development of drug resistance is often due to incomplete or improper treatment regimens, highlighting the need for stringent adherence to prescribed therapies. Accurate and timely diagnosis of TB is crucial for effective treatment and prevention of transmission. However, in many parts of the world, especially in low-resource settings, diagnostic facilities are limited. Traditional diagnostic methods like sputum smear microscopy lack sensitivity, particularly in detecting TB in HIV-positive individuals and children. Delayed diagnosis not only worsens patient outcomes but also facilitates the spread of TB [1].

Tuberculosis (TB) remains one of the most formidable global health challenges, affecting millions of individuals worldwide. Despite significant advances in medical science, TB continues to pose a major public health threat, particularly in low- and middle-income countries. This article explores the global challenges associated with TB, including factors such as drug resistance, diagnostic delays and social determinants of health. Furthermore, it highlights modern solutions and strategies aimed at combating the disease, including advances in diagnostic tools, treatment regimens and preventative measures. By addressing both the challenges and solutions, this article provides a comprehensive overview of the current state of TB control and the path forward to reducing its global burden. Training and retaining skilled healthcare workers who are well-versed in TB management is crucial. This includes continuous professional development and providing adequate resources and support. Improving healthcare infrastructure, particularly in high-burden countries, ensures that diagnostic and treatment services are accessible to all. Investments in laboratories, healthcare facilities and supply chains for TB medications are vital [2].

TB disproportionately affects the most vulnerable populations, including those living in poverty, crowded conditions and with compromised immune systems. Malnutrition, inadequate healthcare infrastructure and lack of access to medical services exacerbate the problem. Social stigma and discrimination further hinder individuals from seeking timely diagnosis and treatment. HIV infection significantly increases the risk of developing active TB. Co-infection with TB and HIV is particularly prevalent in sub-Saharan Africa, where both diseases are endemic. HIV weakens the immune system, making it more difficult for the body to fight TB bacteria. Managing co-infected patients requires integrated care and coordination between TB and HIV treatment programs. Recent advancements in TB diagnostics have significantly improved detection rates. Molecular tests like Gene pert MTB/RIF can simultaneously detect Mycobacterium tuberculosis and resistance to rifampicin within two hours. This rapid and accurate diagnostic tool is crucial for early initiation of appropriate therapy. Additionally, the development of next-generation sequencing (NGS) technologies allows for comprehensive detection of drug resistance, guiding personalized treatment plans [3].

Description

The introduction of new TB drugs, such as bed aquiline and delamanid, has provided hope for more effective treatment of drug-resistant TB. These drugs, when used in combination with other antibiotics, have shown promising results in shortening treatment duration and improving outcomes for MDR-TB and XDR-TB patients. Furthermore, shorter, all-oral regimens are being developed and tested, which could enhance patient adherence and reduce the burden of TB treatment. Preventing TB transmission is a key component of global TB control efforts. The Bacillus Calmette-Guérin (BCG) vaccine, although not highly effective in preventing pulmonary TB in adults, provides significant protection against severe forms of TB in children. Research is on-going to develop more effective TB vaccines. Additionally, preventive therapy for individuals at high risk of developing TB, such as people living with HIV and household contacts of TB patients, is being expanded. Isoniazid preventive therapy (IPT) and newer regimens like the 3HP (a three-month once-weekly regimen of isoniazid and rifapentine) have shown efficacy in reducing TB incidence in these populations. Addressing the social determinants of health is critical for TB control. Integrated healthcare approaches that combine TB treatment with services addressing malnutrition, mental health and socioeconomic support can improve patient outcomes. Community-based interventions and engagement of Non-Governmental Organizations (NGOs) play a vital role in reaching underserved populations and reducing stigma associated with TB [4].

Global initiatives such as the WHO’s End TB Strategy aim to reduce TB incidence by 90% and TB deaths by 95% by 2035. Achieving these targets requires a multi-faceted approach, including political commitment, increased funding and international collaboration. Public-private partnerships are essential in accelerating research and development of new diagnostics, drugs and vaccines. The Global Fund to Fight AIDS, Tuberculosis and Malaria, along with other funding bodies, provides crucial support to TB programs worldwide. The fight against tuberculosis is far from over, but modern solutions and a comprehensive approach offer a pathway to overcoming this ancient disease. By addressing the global challenges and leveraging advancements in diagnostics, treatment and prevention, the global community can make significant strides toward eradicating TB. Collaboration, sustained political commitment and continuous innovation are key to achieving a TB-free world. The concerted efforts of governments, healthcare providers, researchers and communities will be crucial in turning the tide against TB and ensuring a healthier future for all [5].

Conclusion

Tuberculosis continues to be a significant global health challenge, particularly in regions with limited resources and high rates of co-infection with HIV. However, advancements in diagnostic tools, novel treatment regimens and preventative measures offer hope for better control and eventual eradication of the disease. Addressing social determinants of health and strengthening healthcare systems are essential to combat TB effectively. Through global initiatives, partnerships and sustained commitment, it is possible to reduce the burden of TB and move closer to achieving the goals set forth by international health organizations. The fight against TB requires a comprehensive and coordinated effort to overcome the challenges and leverage modern solutions for a TB-free world.

Acknowledgement

None.

Conflict of Interest

There are no conflicts of interest by author.

References

1. Alder, Jonathan K., Julian J-L. Chen, Lisa Lancaster and Sonye Danoff, et al. "Short telomeres are a risk factor for idiopathic pulmonary fibrosis." Proc Natl Acad Sci 105 (2008): 13051-13056.

Google Scholar, Crossref, Indexed at

2. Alter, Blanche P., Philip S. Rosenberg, Neelam Giri and Gabriela M. Baerlocher, et al. "Telomere length is associated with disease severity and declines with age in dyskeratosis congenita." Haematol 97 (2012): 353.

Google Scholar, Crossref, Indexed at

3. Armanios, Mary Y., Julian J-L. Chen, Joy D. Cogan and Jonathan K. Alder, et al. "Telomerase mutations in families with idiopathic pulmonary fibrosis." N Engl J Med 356 (2007): 1317-1326.

Google Scholar, Crossref, Indexed at

4. Habermann, Arun C., Austin J. Gutierrez, Linh T. Bui and Stephanie L. Yahn, et al. "Single-cell RNA sequencing reveals profibrotic roles of distinct epithelial and mesenchymal lineages in pulmonary fibrosis." Sci Adv 6 (2020): eaba1972.

Google Scholar, Crossref, Indexed at

5. Valenzi, Eleanor, Tracy Tabib, Anna Papazoglou and John Sembrat, et al. "Disparate interferon signaling and shared aberrant basaloid cells in single-cell profiling of idiopathic pulmonary fibrosis and systemic sclerosis-associated interstitial lung disease." Front Immunol 12 (2021): 595811.

Google Scholar, Crossref, Indexed at