Research for New tools in TB: what are the needs from the users' perspective

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Research for New tools in TB what are the needs
from the users' perspective ?

• Chakaya JM
• Kenya Medical Research Institute

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The Epidemic
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Understanding the Epidemic in Kenya
Young Adults HIV driven Poverty driven
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The RESPONSE
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• Pursue high-quality DOTS expansion and
  enhancement
• 2.Address TB-HIV, MDR-TB and other challenges
• 3. Contribute to health system strengthening
• 4. Engage all care providers
• 5. Empower people with TB, and communities

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The Diagnostics

• Low sensitivity of Smear Microscopy - performs
  even poorer in the setting of HIV
• The chest x-ray low sensitivity, inaccessible,
  high cost to patients
• Liquid Culture limited availability , limited
  use diagnosis and surveillance of drug
  resistance
• Major problems with diagnosis of EPTB and
  paediatric TB

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The need for a point of care test

• If only we had a

• The Dispensary

• Simple Test
• Cheap Test
• Sensitive Test
• Specific Test
• Single Test for all forms of TB in all ages
• Test that performs well in HIV/HIV-

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Treatment Challenges
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The only BIG ,OLD FIVE

• Fighting to protect five OLD drugs
• Streptomycin
• Isoniazid
• Rifampicin
• Pyrazinamide
• Ethambutol

Care with drug regimen and dosage Care with
adherence(DOT) Care with drug quality
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But things happen even when we have been careful

• Un recognized drug resistance
• Drug resistance recognized too late
• Result Induction or expansion of drug resistance

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The need for new drugs

• To
• Simplify treatment
• Shorten treatment
• While
• Reducing risk of failure , relapse and acquired
  drug resistance.

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Conclusion

• Current TB management tools are inadequate
• Need to develop new tools ( diagnostics, Drugs
  and Vaccines)
• New tools must be affordable and available to
  all
• Adoption at country and provider level must be
  accompanied by appropriate implementation
  research