Tools vs Social Determinants
Andrew Hayward
UCL Professor of Infectious Disease Epidemiology and Inclusion Health
Global Vaccine coverage
Incidence of TB in household contacts
by infection status and intervention
[1]
• Lifetime risk
12%
• >5 years post infection
• 2%
• >10 years post infection
• 0.5%
[1] Ferebee SH. Controlled chemoprophylaxis trials in tuberculosis: a general review.
Bibl. Tuberc. 26, 28–106. 1970
Need shorter less toxic regimes
for LTBI treatment.
Esmail H, et al. The ongoing challenge of latent tuberculosis. Phil. Trans. R. Soc. B 369: 20130437. 2014
Home based DOT
more effective than
clinic DOT
Even tests with high sensitivity and
specificity perform poorly at low prevalence.
Can whole genome sequencing perform better
than Nucleic Acid Amplification tests?
How should we manage
those who we cannot treat?
• A vaccine that only provides partial protection
• Tests for latent infection that cannot predict who will
develop disease
• Preventive treatment prolonged with high NNT
• Radiography remains best tool for screening for
subclinical disease
• Rapid diagnostics but not genuinely "near- patient"
• Prolonged treatment for active disease
• Inadequate approaches for treatment support
• Challenges in rapidly and accurately identifying
MDRTB
• Emergence of untreatable strains
Tuberculosis elimination
not possible with
currently available tools