Finding Tuberculosis​

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​​​​We are advancing knowledge of early asymptomatic TB biology, applying it to mass screening strategies in high-burden settings, and generating the evidence needed to break the transmission chain by effectively and efficiently identifying all individuals with infectious TB, regardless of their symptoms or severity.

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​​​​​Community-wide active case finding (ACF) 

 

Each year, 3-4 million people with TB go undetected and untreated, driving ongoing transmission within communities and sustaining endemic TB (R0 > 1). Our recent cluster randomized controlled trial (ACT3) in Vietnam showed that community-wide active case finding reduced TB prevalence, incidence, and transmission, leading to WHO guideline revisions and paving the way for scalable, efficient implementation in high-incidence settings.

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We are seeking to define optimal methods for detecting all prevalent TB cases in high incidence settings; measure the impacts of ACF and treatment on TB caseload and transmission; conduct consumer-led research to identify the most acceptable screening approaches in different contexts.

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Our Approaches

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Vietnam

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i. Determine optimal ACF screening algorithms and measure the impact of detecting and treating both TB disease and infection (ACT5 trial)

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ii. Implement scale up of ACF using ultra-portable, battery-operated chest X-rays with artificial intelligence (AI) reading

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iii. Address barriers to scaling up ACF for drug-resistant TB

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iv. Determine the costeffectiveness of community-wide ACF

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Papua New Guinea

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i. Scale up TB detection (Ultra-portable chest X-ray with CAD4TB AI reading), including the detection of drug resistant TB (sputum Xpert Ultra/XDR), given that 20% of new cases have multidrug resistant (MDR) TB

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ii. Evaluate the impact to detect and treat both TB infection and disease on age-disaggregated TB and MDR-TB caseloads (SWEEP-TB)

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Indonesia

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i. Examine lessons learnt from a recent community ACF initiative in Yogyakarta linked to the global ‘zero cities’ initiative (PRIME TB)

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ii. Explore combined screening that includes important NCDs (DM and hypertension)

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iii. Implement and evaluate this combined intervention in high TB incidence provinces

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Kiribati

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i. Implement a ‘universal test and treat’ multi-disease screening program, including TB disease, TB infection, leprosy, scabies, and hepatitis B (PEARL)

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New biomarkers for TB diagnosis and treatment response monitoring

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The lack of a simple point-of-care diagnostic test remains a major challenge in global TB control, complicating efforts compared to diseases like HIV, malaria, and COVID-19. While sputum-based PCR diagnostics are accurate, they are costly, require laboratory infrastructure, and rely on difficult-to-collect sputum samples, missing about one-third of TB cases with false negatives. Non-sputum-based tests are urgently needed to identify all TB patients, break transmission cycles, and monitor treatment responses. Recent studies indicate that over 30% of TB patients may be asymptomatic, highlighting the need for early diagnosis. Two potential blood biomarker signatures and a novel 3-gene host response assay using fingerstick blood are being evaluated for improved diagnostics. We are seeking to develop biomarkers for TB risk profiling, TB disease diagnosis and treatment response monitoring; and progress the most promising biomarkers to large scale validation studies.

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Our Approaches

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We have biobanked specimens from well-characterised cohorts with TB. These specimens will be used to assess the biomarker potential of various signatures. The TB-CRE also provides the collaborative network to undertake additional validation studies as part of future trials. Our Australasian clinical research network is well-positioned to evaluate biomarkers that identify individuals with latent TB at risk of reactivation disease.