In the Spotlight: Ending TB in Africa
On 24th March millions of people around the world celebrated World TB Day, whose theme this year – “Yes! We can end TB!” – aimed to inspire hope and encourage increased investments, innovations, accelerated action, multi sectoral collaboration and stronger political will to combat the TB epidemic.
Despite advances in research, drug development and treatment, TB remains one of the leading causes of infectious disease death in the world today. The World Health Organization (WHO) estimates that 1.6 million people died from TB in 2021, with over 25 percent of these deaths occurring in the African Region.
This week H3D Centre’s Dr. Nashied Peton, Investigator, TB Biology, shares his take on the factors contributing to Africa’s high TB burden, and offers insights into what can be done to lower its prevalence on the continent. Read on for more!
Please tell us more about your area of expertise in tuberculosis (TB) and how you ended up working in the drug discovery space?
I am a molecular biologist and medical scientist by training. I currently work as an Investigator in TB biology at H3D, Holistic Drug Discovery & Development Centre, in Cape Town, South Africa, where I manage the TB biology screening platform which provides support to both in-house and external TB drug discovery projects in the form of in vitro primary and secondary screening assays and mechanism of action studies on promising compounds.
Previously I worked in infectious disease immunology studying the effects of Mycobacterium tuberculosis (Mtb) infection on the host macrophage inflammatory response and how potential modulation of this inflammatory response using small-molecule inhibitors can reduce immune dysregulation and prevent immunopathogenesis.
From this point, it seemed natural to transition from host-directed therapy research to pathogen-based drug discovery.
What factors have contributed towards making Africa’s TB burden higher than the global average?
A number of socio-economic factors are contributing to this statistic. There’s the higher prevalence of HIV infection in Africa which increases an individual’s risk of developing TB disease; the lack of adequate and accessible health care; the lack of education and understanding of the disease; malnutrition such as vitamin D deficiency in under-developed countries, poverty and poorly ventilated living and working conditions are all contributors to Africa’s higher TB burden.
COVID-19 saw the diversion of research and resources from other key areas of research such as TB. What has the impact of this been on Africa’s efforts to end TB?
The impact of COVID-19 critically affected the fight against TB and the progress made towards ending TB, particularly in lower-income countries where resources were diverted towards dealing with the pandemic at the time. This resulted in those most vulnerable, the poor, feeling the socio-economic impact, as the already limited health resources for TB in our African countries were further depleted to cope with the pandemic. This meant that those most in need were left facing even more challenges in accessing diagnostic healthcare services and TB treatment.
As someone with extensive research experience in this field, what are some common and harmful misconceptions surrounding TB in Africa, and what steps can we take to address them?
One of the most common and harmful misconceptions of this disease, particularly in underdeveloped TB endemic countries, is its mode of transmission. Some people still believe that TB can be transmitted though handshaking, sharing of utensils and even commuting with public transport. This suggests either a lack of resources to educate individuals on TB, or an inadequate and inefficient distribution of available resources to those in need of understanding what TB is, how its transmitted and building awareness towards identifying the early signs and seeking treatment. The stigma associated with this disease can have a negative impact on the infected individual who may withdraw from society and delay seeking the appropriate treatment.
Identifying the gaps in educating our poorer communities on TB disease may significantly reduce prevailing perceptions about TB and the rate of TB transmission, as well as improve treatment success rates.
Multidrug-resistant tuberculosis (MDR-TB) has been a huge roadblock in curing and eliminating TB. What are some initiatives that African countries can take to lower the prevalence of MDR-TB?
Developing more rapid diagnostic tests that are accurate and reliable for the early detection and treatment of TB will have a direct impact on reducing the rate of transmission of this disease and ultimately the incidence rates of MDR-TB. Developing better treatment regimens that are effective, shorter and easier to adhere to, will also contribute significantly to a reduction in the number of MDR-TB cases. In addition, patient monitoring and surveillance needs to be increased to ensure treatment regimens are strictly adhered to for the recommended duration. These factors all contribute towards enhanced disease resolution and higher rates of success in managing MDR-TB.
The theme of World TB Day 2023 was "Yes! We can end TB!". In what areas do we need to invest to ensure the end of TB?
We need to continue investing resources and funding into TB research in order to develop shorter drug regimens and faster, more accurate diagnostic tools for detecting the early subclinical stages of this disease, as well as identifying those most at risk of progressing towards the active symptomatic TB spectrum, so that treatment options can be initiated early.
The utility of host-directed therapies as an adjunct to existing therapies also needs to be explored more aggressively. Continual investment in educating individuals on the disease as well as addressing the risk factor of malnutrition may all collectively contribute towards ending TB eventually.
What does the future of TB research and treatment in Africa look like, and how has this inspired African researchers and scientists to join in the fight against TB?
Africa continues to engage in ground-breaking research to fill the knowledge gap in understanding the spectrum of TB disease, with drug discovery in Africa advancing rapidly. H3D serves as an example of Africa’s first integrated drug discovery centre that focuses on developing innovative, life-saving medicines and building Africa-specific models to contribute to improving treatment outcomes in African patients while simultaneously training African scientists in drug discovery-related sciences.
Africa is also becoming a hub for TB clinical research centres such as TASK, which conducts clinical trials to determine the treatment effects of novel therapeutics. These endeavours combined have inspired young African scientists to join in the fight against ending TB, with these efforts eventually translating into the accelerated development of shorter, more effective treatment options and improved health policies for TB treatment overall.