Karin Kanewske Turner’s eyes light up when she talks about a new treatment that is faster at snuffing out TB bacteria than anything previously available.
Billions of people are infected with TB bacteria —a condition known as latent TB— and are at risk of developing the disease, especially children under five and people living with HIV. Active TB makes people dangerously ill and is infectious.
Turner works for South Africa’s Aurum Institute and oversees the Unitaid-funded IMPAACT4TB project to introduce the new drug, 3HP, as a preventive therapy for those at most risk of developing active TB.
Winning hearts and minds
The biggest challenge facing the project is winning over countries and their clinicians to adopt 3HP, and convincing people who otherwise feel healthy to take the drug. 3HP requires only once-weekly treatment for 12 weeks, compared to the six-to-36-month daily regimen required under the older standard of care.
"A lot of countries hardest hit by TB only focus on treatment, but prevention is something they will need to invest in to end the epidemic," says Turner.
She is also confident that clinicians can be brought round to prescribing 3HP.
"There are myths about drug resistance developing among people on preventive treatment. We will do lots of training and show them this is not the case," explains Turner.
Persuading those at risk of developing active TB to take preventive therapy may prove harder, she says.
“Getting people who are feeling well to take prevention pills is one of the major obstacles we seek to address," Turner notes.
Civil society, she says, has an important role to play in spreading the word about the drug’s advantages.
In a significant breakthrough, the Aurum Institute and partners announced in March that 3HP can be taken safely by people on dolutegravir, a first-line HIV treatment. The findings open the way for putting up to 600,000 people on 3HP in 12 high-burden countries on three continents.
Countries outside the scope of the project are showing interest in 3HP, and governments—Indonesia and Ghana among them—are considering investing part of their Global Fund grants in it. Success in scaling up 3HP requires the initiative to work in close coordination with governments and big funders.
"We need to send the message that more and better TB prevention matters, and this has to be a joint message from Unitaid, PEPFAR and the Global Fund. We must speak with one voice."
Turner cites three immediate priorities: bringing quality generics to the market, giving "train-the-trainer" courses to prepare for 3HP implementation, and helping countries set up supply-chain systems and evaluation programs.
"It is time to pay the same attention to innovations in TB as we have payed to new products in HIV," she concludes.