The newly designated World Health Organization Collaborating Centre for Tuberculosis (WHO Collaborating Centre for TB) at the University of Sydney will serve as a regional resource to reduce the global burden of TB, which remains the leading infectious disease killer on the planet. The Sydney WHO Collaborating Centre for TB will work with WHO to develop the evidence base and strategies required to meet the ambitious targets of the End TB strategy, including a strong focus on the threat posed by drug-resistant TB (DR-TB). It will complement support provided by colleagues at the Korean Institute of Tuberculosis, The Japanese Research Institute of Tuberculosis and the National Center for TB Control and Clinical Medicine, CDC China, to address major gaps in evidence synthesis, strategic analysis, policy development, testing of novel elimination strategies and support of countries with limited capacity, specifically in Western Pacific Region.
The WHO Collaborating Centre for TB will link closely with the NHMRC Centre of Research Excellence in Tuberculosis Control on both sides of our border (TB-CRE).
TB remains an enormous health problem worldwide and rising rates of drug resistant TB in the Asia-Pacific region pose a particular threat to Australia. The WHO’s new End TB strategy aims to drastically reduce TB case numbers, deaths and socio-economic impacts by 2035. This CRE will harness expertise in clinical, laboratory and community research to help provide the necessary evidence and new tools to eliminate TB transmission in Australia and strengthen TB control in our region.
Tuberculosis (TB) remains an enormous health problem worldwide and rising rates of drug resistant TB in the Asia-Pacific region pose a particular threat to Australia. The WHO’s new End TB strategy aims to drastically reduce TB case numbers, deaths and socio-economic impacts by 2035. The the "NHMRC Centre for Research Excellence in Tuberculosis Control on both sides of the border” at the University of Sydney will harness expertise in clinical, laboratory and community research to help provide the necessary evidence and new tools to eliminate TB transmission in Australia and strengthen TB control in our region.
The emergence and spread of antibiotic resistant strains of Mycobacterium tuberculosis is a major concern globally. Within the Pacific, tuberculosis (TB) hotspots such as Kiribati pose a particular challenge and threat. The overarching objective of the proposed body of work is to mitigate the threat posed by drug resistant tuberculosis (DR-TB) in the Pacific, by enhancing knowledge and testing new strategies to combat DR-TB. DR-TB emerges through drug resistance acquisition due to the selective pressure of antibiotics (called secondary resistance) and transmission of these DR-TB strains within the community (called primary resistance); this research project will address both of these drivers of the DR-TB epidemic. Drug resistance acquisition occurs when patients with initial drug susceptible TB receive inadequate drug exposure resulting from a weak treatment regimen, poor drug quality, or non-adherence to treatment. Optimal care of drug susceptible (DS)-TB cases is essential to “turn off the tap” and prevent newly acquired drug resistance, while enhanced care of DR-TB cases is important to prevent multiplication of drug resistance (acquisition of resistance to additional TB drugs), as well as ongoing transmission of drug resistant strains within communities.
This research will provide a pathway towards DR-TB prevention and TB elimination in the Pacific by:
Drug resistant tuberculosis is a major barrier to global TB control. The VQUIN MDR Trial, a randomised controlled trial, is being undertaken in Vietnam to evaluate the effectiveness of an oral antibiotic, levofloxacin, upon the incidence of tuberculosis among contacts of patients with drug-resistant TB. The trial has recruited over 2,000 participants across 10 provinces of Vietnam. It will provide evidence to inform global guidelines regarding prevention of drug resistant TB. The study is funded by the Australian National Health and Medical Research Council, and implemented in collaboration with the Vietnam National Tuberculosis Program.
Treatment for drug-resistant TB is a substantial challenge, particularly due to its toxicity and prolonged duration. The VSMART trial is evaluating the effectiveness of a smartphone App to support patients with drug-resistant tuberculosis in Vietnam to complete their treatment. The trial is underway in 6 provinces of Vietnam, in partnership with the Vietnam National Tuberculosis.
The ACT5 trial is a community-based study in rural Vietnam evaluating the effect of a community-wide programme of tuberculosis preventive therapy. We will enrol over 100,000 people, and offer treatment with antibiotics to prevent tuberculosis. The study aims to reduce the prevalence of TB, and contribute evidence to guide global TB elimination efforts. The study is funded by the Australian National Health and Medical Research Council, and implemented in collaboration with the Vietnam National Tuberculosis Program.
The VRESIST Trial aims to understand and address the challenge of antibiotic resistance in resource-limited settings. In partnership with the Vietnam National Institute of Hygiene and Epidemiology, this study evaluates current practice regarding antibiotic use and patient referral in 4 provinces of Vietnam. We have undertaken a series of standardised patient surveys to characterise the behaviour of private pharmacists when consulted by patients with presumptive tuberculosis. The study will inform efforts to increase referral for patients with TB in the private sector. The study is funded by the Australia Department of Foreign Affairs and Trade, and implemented in partnership with the National Institute of Hygiene and Epidemiology and other local partners.
An Expert review was undertaken for the WHO Guideline Development Group on TB Screening. The evidence review was led by Dr Greg Fox and Dr Kavi Velen at the University of Sydney. The review focused upon TB screening among household contacts of patients with TB, contributing to updated 2021 WHO TB Screening Guidelines.
WHOCC-TB has been designated a World Health Organisation (WHO) Collaborating Centre in support of WHO’s work in implementation of the End TB Strategy in the Western Pacific and broader Asia-Pacific Region, particularly through the facilitation of research collaboration, evidence synthesis, provision of technical advice and supporting links with the Australian TB community.