Drug-resistant tuberculosis (TB) and latent TB infection in high and low incidence setting

Abstract

Tuberculosis (TB) remains the world’s second leading cause of death from a single infectious agent in 2022 after COVID-19[1]. The global number of people newly diagnosed with TB was over 10 million in 2022 [1]. There were an estimated 450 000 incident cases of MDR/RR-TB in 2021, with an estimated 191 000 deaths due to MDR/RR-TB[2].

The overall aim of this thesis was to evaluate the prevention and treatment of people affected by drug-resistant and drug-susceptible TB. (i) Evaluate the current programmatic management of patients receiving individualised antibiotic therapy for MDR/ RR-TB in the city of Sydney, Australia and the treatment outcomes. (ii) Evaluate the management of people at high risk of MDR/RR-TB in NSW with multidrug-resistant tuberculosis in New South Wales, Australia. (iii) Identify risk factors for TBI in the HHC of MDR/RR-TB patients and the prevalence of TBI among MDR/RR-TB contacts in Vietnam. (iv) To evaluate the feasibility and acceptability of weekly rifapentine and isoniazid (3HP) using digital treatment adherence reminders in Sydney, Australia.

Our study findings demonstrate the effectiveness of individualised therapy for drug-resistant TB in a high-income setting. We demonstrated the prevalence of TB infection in a high-burden setting, Vietnam, was high - in contrast to the low number of individuals with TB infection among those contacts of MDR/RR-TB patients in Australia. Finally, we have shown high completion of preventive therapy among people with TBI in Australia. These are only a small part for the roadmap to achieve the End TB Strategy. Further research is required to for different country to achieve the WHO End TB strategy by 2035, it is not a “one size fits all” approach and its success depends on adaptation for diverse country settings.