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EPiTB: Addressing an unmet need: same day diagnosis of extra-pulmonary TB in a high burden setting.

Project description

Improved TB diagnosis in Africa

Tuberculosis (TB) remains a significant public health challenge in Africa, exacerbated by suboptimal diagnostic approaches. Extrapulmonary TB (EPTB) accounts for approximately 15 % of the TB burden, with this figure soaring to over one-third in HIV-endemic regions. Current diagnostic methods, such as GeneXpert, struggle with EPTB, especially in pleural cases, where sensitivity is around 35 %. The EPiTB project addresses this urgent shortfall by promoting IRISA-TB, a low-cost, same-day diagnostic test specifically designed for EPTB. Developed by a South African start-up, this innovative test has already shown promise in clinical trials and is set for a large-scale multicentric study involving 2 170 patients, paving the way for improved TB diagnosis and care in Africa.

Objective

Better diagnostic approaches are required to improve TB control in Africa, which is suboptimal. One neglected aspect of TB diagnosis is that of extrapulmonary TB (EPTB), which comprises ~15% of the TB caseload. However, in HIV-endemic settings over one third of cases are due to EPTB (the most common manifestation being pleural TB). Frontline same day sputum-based diagnostic tools such as GeneXpert perform poorly when using fluid derived from EPTB-specific compartments (e.g. pleural fluid). Indeed, GeneXpert sensitivity in pleural TB is ~35%. ADA, the current standard of care used in clinical practice has poor specificity, especially in pericardial TB and TB-meningitis (see preliminary data). By contrast, unstimulated interferon-gamma (not T-cell-based IGRAs that require overnight stimulation) is an excellent biomarker for the diagnosis of EPTB (confirmed in 2 meta-analyses). A South African university start-up has now developed a low-cost same-day EPTB diagnostic test (IRISA-TB), which has been evaluated and published in several small clinical trials (see main proposal) and is locked-in for scale-up dissemination in 2022. The test is CE marked, SAHPRA approved, and endorsed by the Global Fund. This proposal encompasses a large prospective multicentric study (n= 2170 patients) of IRISA-TB in various forms of EPTB (pleural, pericardial, and peritoneal TB, and TB meningitis). The proposed study (EPiTB) has excellent fidelity with the EDCTP call because it will enable “the registration of a new health technology through pragmatic effectiveness studies”, “enable uptake of results into clinical practice” and facilitate WHO endorsement. Thus, EPiTB will drive the facilitation and uptake of an important new TB diagnostic test in Africa. Importantly, an African-invented and designed test will be promoted. Indeed, innovation and the development of an African knowledge-based economy is a key priority of the EDCTP.

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Topic(s)

Funding Scheme

HORIZON-JU-RIA - HORIZON JU Research and Innovation Actions

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Call for proposal

(opens in new window) HORIZON-JU-GH-EDCTP3-2022-01

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Coordinator

UNIVERSITY OF CAPE TOWN LUNG INSTITUTE PTY LTD*
Net EU contribution
€ 2 618 391,15
Total cost
€ 2 618 391,15

Participants (3)