Research across a wide spectrum of areas is necessary to accelerate progress in global TB control and enable the revolution in technologies for TB control needed to achieve the goal of eliminating the disease by 2050. Key areas of research include:
applied research, i.e. optimizing the use of current approaches to TB control through epidemiological, programmatic, health systems, health economics, and social and policy research;
development of new tools, i.e. research and development (R&D) for new diagnostics, drugs and vaccines;
evaluation and demonstration of new tools (diagnostics, drugs and vaccines);
basic research, i.e. improving understanding of the basic science that underpins the development of new tools.
28.1. National TB control programmes and the Research Movement to Stop TB
Recognition of the importance of TB research is reflected in the Stop TB Strategy. The Research Movement to Stop TB, mandated in 2006 by the Stop TB Partnership and WHO, represents an opportunity to engage the full range of TB researchers in a collaborative strategic effort to increase the scope, scale and speed of TB research. The success of the Research Movement as a broad alliance of all those involved in TB research depends on engaging the full range of researchers in basic research, R&D and applied research (including the NTPs).
28.2. Applied research
Making the most of current approaches to TB control depends on the contribution of many areas of applied research: epidemiological, programmatic (operational), health systems, health economics, and social and policy research. Research in these areas should involve NTPs, since the aim is to improve programme performance. NTPs have a crucial role to play in designing and carrying out operational research that involves the evaluation of programme operations aimed at improved policy-making, better design and operation of health systems and more efficient methods of service delivery. The NTP should develop effective collaboration with researchers from academic or other research institutions who often play the lead role in carrying out operational research.
28.3. Development of new tools for TB control
Progress in global TB control is constrained by the lack of effective new tools (diagnostics, drugs and vaccines). The Stop TB Partnership and WHO are promoting the development of better technologies for preventing, and improving the diagnosis and treatment of, TB through the Partnership's three working groups on new tools development. These working groups (on new diagnostics, drugs and vaccines) aim to provide better technologies for preventing TB, and to accelerate the process of diagnosis and treatment, especially in regions where TB/HIV and MDR-TB make TB control particularly difficult. The Stop TB Strategy emphasizes the need to develop better technologies for preventing, and improving the diagnosis and treatment of, TB at affordable cost for developing countries. Creative intellectual property mechanisms are being developed that protect the public health sector and enhance access to new technologies by underprivileged patients.
In 2006, the Stop TB Partnership Coordinating Board established a Task Force on Retooling to respond specifically to the need to prepare for the launch of new TB technologies.1 “Retooling” is the process of introduction, adoption and implementation of new and improved diagnostics, medicines and vaccines, with the goal of maximizing their widespread use while minimizing delays. To be successful, the retooling process involves the participation of a wide range of stakeholders at the global and country levels and the consideration of a number of key components, including an assessment of a country's capacity to adopt and implement a new technology.
28.4. Evaluation and demonstration of new tools
NTP managers need to keep abreast of research developments. The NTP has an essential role in the establishment of clinical trial platforms for the evaluation and demonstration of new tools (diagnostics, drugs and vaccines). Clinical trials require standard ethical approval. As new tools become available, NTP managers will be involved in the process of ensuring their smooth and rapid transition directly to the field. Preparations for incorporating new tools into NTP activities include regulatory approval of new tools, developing purchasing mechanisms and training the health-care workers who will use and administer them in the field.
28.5. Basic research
More basic research is necessary to address fundamental gaps in the science and understanding of the biology and pathogenesis of M. tuberculosis. Advances in basic TB research are needed to generate the discovery of new agents to sustain the pipeline of research and the development of new tools. Through the Stop TB Partnership, NTPs may play a role in advocating for increased investment in fundamental scientific research on TB to fortify the foundations of knowledge that will lead to key advancements in the field.
Key references
Hardon A, et al. Applied health research-manual: anthropology of health and health care. revised edition. Het Spinhuis; Amsterdam: 2005.
Harries AD. Integration of operational research into National Tuberculosis Control programmes.
Tuberculosis. 2003;83:143–147. [
PubMed: 12758204]
New technologies for tuberculosis control: a framework for their adoption, introduction and implementation. Geneva: World Health Organization; 2007.
Scientific Working Group on Tuberculosis. Meeting report. 3–6 October 2005, Geneva, Switzerland. Geneva: World Health Organization; 2006. Special Programme for Research and Training in Tropical Diseases (TDR). (TDR/SWG/06)
