Clinician talking to patients
Melissa Sanchez, a patient with extensively drug-resistant TB, is treated for the disease under the supervision of a nurse conducting a home visit. The nurse is administering treatment via a central venous catheter.
Photo: by Zack DeClerck/Socios En Salud

Tuberculosis

Tuberculosis

Tuberculosis (TB) is a common, and in many cases lethal, infectious disease. It usually attacks the lungs, but also can affect other parts of the body. TB is spread through the air, when people who have an active TB infection cough or sneeze. Symptoms of TB include a chronic cough with blood-tinged sputum, fever, night sweats, and weight loss. Diagnosis relies on chest X-rays, a tuberculin skin test, and blood tests, as well as sputum samples.  

People with weakened immune systems, from diseases such as HIV, diabetes, or malnutrition, are particularly susceptible to TB. Worldwide, TB remains a leading cause of death for people with HIV. 

TB, like many infectious diseases, glaringly reveals health care inequities. According to the World Health Organization, it  is the deadliest infectious disease in the world, infecting 10 million people in 2018 and killing 1.5 million. More than 95 percent of those cases and deaths occurred in developing countries. 

PIH has battled this inequity for more than two decades, by treating and preventing TB, its more severe, drug-resistant variants, and co-infections of HIV and TB in some of the poorest and most vulnerable communities in the world. Our community-based approach to care has resulted in some of the highest cure rates and lowest treatment default rates ever recorded. 

Our Impact

77% cure rate for MDR-TB thanks to new drugs.

Community-based Care 

PIH’s approach to TB care relies upon community health workers (CHWs), who serve as a vital link between their communities and medical facilities. CHWs deliver drugs and treatment support to patients who require complex drug regimens, and provide TB drugs and antiretroviral therapy to patients co-infected with TB and HIV. They also monitor the health of their neighbors, perform active case finding, and refer sick patients to health facilities—often accompanying them there in person. 

PIH and endTB 

Historically, standard tuberculosis treatments lasted up to two years and included painful daily injections and drugs that have multiple side effects, sometimes including deafness and other devastating ailments.   

The endTB project is working to dramatically improve treatment of multidrug-resistant tuberculosis (MDR-TB), through clinical trials of new drugs and shorter treatment regimens that involve only oral medicine and the elimination of daily injections. PIH works in the endTB partnership with Médecins Sans Frontières (Doctors Without Borders), Interactive Research and Development, and financial partner UNITAID. 

The group has brought two new drugs—bedaquiline and delamanid—to 17 countries with significant burdens of MDR-TB. The endTB project has provided these new drugs to a multi-country group of 2,600 patients and is implementing clinical trials to identify shorter, less toxic treatment regimens than those currently used.  

The hope is to dramatically expand access to these new drugs and treatment regimens globally  and ultimately improve the quality of life for countless patients. 

Kazakhstan, Lesotho, and Peru are PIH-supported countries that have been included in endTB’s work.  

In Kazakhstan’s capital of Almaty, PIH and the national health department have collaborated on clinical trials for more than 100 MDR-TB patients , as part of the world’s largest TB drug trial.  

In Lesotho’s capital of Maseru, the PIH-supported Botšabelo Hospital is the only MDR-TB treatment facility in the country, and the hub of a national TB outreach, education, and care program.  

In Peru, innovations including TB Movil, a mobile TB clinic on wheels, help PIH teams reach people in neighborhoods in and around Lima for TB screening, testing, and support.  

Innovations in Care  

Mobile clinics are one way in which PIH is finding innovative solutions to bringing TB treatment directly to vulnerable people and communities.  

In Kazakhstan, the PIH team is using video treatment support—video calls between clinicians and patients at home—to maintain connections and checkups with patients who aren’t able to leave their home or neighborhood because of financial, health, or other factors.  

PIH’s approach to TB care is changing local, national, and global models for fighting the disease. Three of our original MDR-TB pilot projects have successfully been handed over to ministries of health, where they can be scaled up nationally and leaders can provide training and technical assistance to other countries in their regions. 

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