Research Priorities for Tuberculosis
A comprehensive TB research plan should be developed that identifies major areas of need, with CDC and NIH convening experts and stakeholders to create this plan, prioritizing improved diagnostics and therapies for latent TB infection (LTBI), new vaccine development, and clinical/operational/behavioral research to address gaps in TB control. 1
Priority Research Areas
Diagnostics and LTBI Treatment (Highest Priority)
Development of improved diagnostic tests and therapies for LTBI represents the highest impact research priority, as these would have immediate and lasting effects on TB incidence 1
Operational, economic, and behavioral studies are needed to determine the most effective use of new diagnostics as they are introduced to TB control 1
Research should focus on delineating the advantages of newer diagnostic tests (such as interferon-gamma release assays) across different populations, including contacts of infectious cases, children under 17 years, pregnant women, and immunocompromised patients including those with HIV 1
Vaccine Development
Research leading to a new and effective TB vaccine is identified as one of the most important contributions to the global TB epidemic and should be a priority 1
This represents a critical contribution to addressing the global burden of disease beyond national borders 1
Clinical and Operational Research
Additional research including clinical, operational, behavioral, and economic studies should focus on unanswered questions relating to basic elements of TB control, as many current recommendations are based on logic, anecdotal experience, and expert opinion rather than rigorous evidence 1
Behavioral and social science research is urgently needed to understand patient and healthcare provider behaviors related to treatment adherence, with findings used to design interventions that improve adherence 1
No comprehensive effort has been undertaken to examine and compile existing adherence research results and identify best practices, representing a critical gap 1
Epidemiological Research
TB-control programs should remain aware of TB disease resulting from current transmission when conducting epidemiologic surveillance and contact investigations 1
M. tuberculosis genotyping should be immediately available to any program investigating possible transmission 1
Research should address newly identified facets of TB epidemiology as the disease landscape evolves 1
Research Infrastructure and Collaboration
Consortium Models
The CDC-funded Tuberculosis Epidemiological Studies Consortium and Tuberculosis Trials Consortium represent excellent models for bringing together federal government, public health agencies, and academic resources to plan and implement research for assessing new diagnostics and drugs, as well as epidemiologic and operational research 1
These initiatives should be prioritized as they provide effective frameworks for collaborative research 1
International Collaboration
Operational and epidemiological research should address key constraints in implementing control and elimination policies and evaluate the impact of specific interventions and new technologies 1
Research priorities include operational aspects such as setting up notification systems, cross-notification with laboratories, surveillance of drug resistance, monitoring treatment results nationally, ensuring adherence in specific populations, and documenting screening activity outcomes 1
Cost-effectiveness of screening has rarely been evaluated and represents an urgent research need 1
Specific Research Questions by Domain
Drug Development
Drug development is the most frequently cited priority area across existing priority statements (appearing in 28 of 33 priority documents reviewed) 2
Treatment and prevention of multidrug-resistant TB in people co-infected with HIV represents the most focused research question 2
Diagnostic Research
Diagnosis and diagnostic tests rank as the second most common priority (27 of 33 documents) 2
Identifying the best combination of existing diagnostic tools for early diagnosis ranks as the top research question overall 3
Treatment Research
Highly ranked treatment-related questions center on reasons for and interventions to improve treatment outcomes, adverse effects of drugs, and optimal treatment duration 3
Research should address the complexity of TB diagnosis even with newer molecular tests, as studies show that single molecular tests may identify less than half of those ultimately started on TB treatment in high HIV-burden settings 4
Critical Gaps Requiring Research
Healthcare Provider Education
In an era of declining TB rates, expertise in recognition, diagnosis, and treatment is likely to decline, especially in low-incidence areas 1
Institutional education programs for healthcare workers, including physicians in training, should be a continuing priority, as delayed diagnosis increases transmission risk 1