To commemorate World TB Day on Thursday 24 March, each day this week we will feature a different aspect of the fight against TB
Thirty years ago treatment for tuberculosis was revolutionized by the introduction of a new drug called rifampicin. The new drug halved the length of treatment and removed the need for painful injections. Yet until only a few years ago many African countries did not make full use of rifampicin in treatment, exposing many patients to a greater risk of treatment failure. After a large multicentre randomized controlled trial showed the weaknesses of this practice, donors and policymakers began to insist that patients everywhere received the best possible treatment.
Recent years have seen an upsurge in new technologies for and approaches to the control of tuberculosis. New methods of diagnosis based on molecular testing have been developed and made appropriate for use in developing countries. Vaccines aiming to improve on the current TB vaccination Bacille Calmette Guerin (BCG), are also being tested while completely new drugs have begun to enter clinical trials. Understanding the effectiveness and appropriate implementation of these tools can be complex and finding ways to summarize and disseminate the evidence is crucial.
The Cochrane Infectious Diseases group at LSTM, led by Professor Paul Garner, carries out systematic reviews of the existing evidence of interventions for tuberculosis. More than twenty reviews in the Cochrane Library help to support the decisions of TB policy makers. Evidence on the effectiveness of new drugs such as rifabutin and fluoroquinolones has helped to inform their place in combination treatment. The group has also looked at the effectiveness of supervision of treatment and other strategies for helping patients stick to their treatment. Many new reviews reflecting an expanding variety of approaches in the field are in preparation, helping to ensure that future policy truly reflects the best evidence available.