Table 3 Research priorities for TB in South Asia

Engaging the public sector to capture notifications and ensure treatment quality

Understanding components of successful Public Private Mix(PPM) models and resources needed for national scale-up

Optimal algorithms and implementation behaviour

Improving application of optimal diagnostic algorithms.

Facilitators and barriers to diagnostic access

Removing access barriers for TB diagnosis in underserved populations

Childhood TB

Access to TB diagnosis for all children at risk

Targeting Active Case Finding (ACF)

Understanding how to target ACF activities to maximise yield for minimal resources.

Mobile health applications for TB

Minimising loss to follow up in diagnostic pathway and maximising outreach of novel diagnostics. Eg. Remote Chest Xray reading.

Scale up of Drug Susceptibility Testing(DST) availability

Increasing access to full drug susceptibility testing through molecular scale-up and improving culture facilities in underserved populations.

Integrating TB and diabetes

Understanding risk factors for TB among diabetic patients and optimal implementation of TB screening.

Increasing Randomized Controlled Trial (RCT) capacity

Develop regional network and ability to systematically evaluate multiple regimens in adequately powered trials.

Treatment of drug resistant TB, including INH mono-resistance, Multidrug Resistance(MDR) and Extensively Drug Resistance (XDR) TB.

Programme of trials to systematically answer locally relevant questions, including both alternative regimens and treatment delivery strategies

Theoretical and practical studies to understand consequences of different approaches to novel drug roll-out

Optimising novel drug implementation in terms of negative outcomes averted and preventing emergence of resistance.

Increasing drug resistance surveillance

Evaluating strategies applying molecular technology to increase monitoring of drug resistance prevalence and emergence

Systematic evaluation of variation in pharmacokinetics and pharmacodynamics

Dose optimisation for existing drugs in adults and children to maximise efficacy, minimise adverse events and prevent resistance.

Adverse drug events

Understanding susceptibility risk, improved detection and management of Adverse Events (AEs) and development of personalised regimens to avoid AEs.

Retreatment regimen in non-MDR cases

Retreatment regimens that are economically feasible and effective allowing abolition of the currently failing ‘category 2’ retreatment regimen.

Mobile health for Video Directly Observed Therapy (V-DOTS) and adherence

Alternative strategies for treatment monitoring to increase compliance while minimising costs and disruption to the patient.

Optimal treatment of TB in diabetic patients.

Evidence base for optimal treatment and case management of TB in diabetic patients.

Correlates of immunity

Understanding of components of a protective immune response for vaccine development.

Standardising implementation of basic infection control in health care facilities regionwide

Development of evidence- based recommendations for minimal infection control standards in regional health care facilities.

Targeted prophylactic therapy

Evidence base for risk:benefit of scale-up of prophylactic treatment in different population groups.

Strengthening health systems resilience

Contingency measures for natural or political upheavals leading to person displacement or infrastructure loss

Heterogeneity of risk in populations

Understanding molecular epidemiology of TB susceptibility and transmission in both dispersed rural and high density urban populations. Optimal targeting of TB control activities to appropriate risk groups.

Risk of active TB in latently infected individuals

Biomarkers and social factors influencing risk for latently infected individuals developing active TB to optimise targeted prophylaxis.

Host:pathogen interaction in susceptibility and transmission

Integrated analysis of host and pathogen genomes to understand complex interplay of host susceptibility and pathogen virulence.