Tuberculosis (TB) today rivals HIV/AIDS as the leading cause of death from infectious diseases. The number of TB patients has never been higher and the growing proportion of drug-resistant TB is threatening control strategies both in the developing and developed world, Eastern Europe being a particularly worrying point in case. The anTBiotic consortium aims to fuel the long-term TB clinical pipeline while immediately offering new options to clinicians when confronted with multidrug-resistant (MDR)-TB. More specifically, the proposed studies aim to: a) Establish the proof of concept of anti-TB efficacy in humans of a pioneering, first-in-class, low-dose GSK oxaborole clinical drug candidate; b) Identify a combination of β-lactam antibiotics suitable for the treatment of MDR TB orally or as a once daily intravenous or intramuscular application and c) Incorporate the best β-lactam combination into an explorative salvage regimen for untreatable patients with extensively drug-resistant TB The anti-TB activity in humans will be established in a two-week EBA clinical studies that combine established (CFU, TTP) and new clinical markers (biomarkers, PET/CT). These datasets will help ascertain anti-TB efficacy in humans and generate confidence on their validity in longer-term drug combination trials. A variety of modelling approaches to predict optimal dosing will be used. Finally, we intend to use at least one of these novel anti-TB entities as part of a pioneering, non-controlled clinical trial in highly drug resistant subjects in Europe and South Africa. This final clinical intervention will hopefully be of immediate benefit to drug-resistant patients in the EU and elsewhere in addition to generating a strong precedent for further adoption worldwide.

The COVID-19 pandemic had a devastating impact on tuberculosis (TB) control. In 2020, the number of people newly diagnosed with TB decreased by 18% despite a rising global TB burden. Intensified efforts to improve TB case detection are critically needed, especially in populations in whom bacteriological confirmation is suboptimal, such as children and people living with HIV (PLHIV) who have also been disproportionately affected by the pandemic. The need for highly sensitive sputum-free diagnostic tools for TB has never been greater. STool4TB, an EDCTP-2 funded diagnostic trial, began its activities in 2020 shortly after the onset of the COVID-19 pandemic. The study aims to validate a novel quantitative PCR assay utilizing a stool homogenization and DNA isolation method that yields a highly sensitive and specific detection of Mycobacterium tuberculosis. STool4TB is implemented in high TB & HIV burden settings of Mozambique, Eswatini, and Uganda under the hypothesis that it will contribute to narrow the large TB case detection gap by improving TB lab-confirmation rates in children and PLHIV, while proving feasible and acceptable. New evidence suggests that this platform has a higher sensitivity when compared to sputum culture and Xpert Ultra and could have an additive lab-confirmation yield of up to 20%. STool4TB is also evaluating the qPCR platform as a treatment monitoring tool. This assay has the potential to be adapted to a POC diagnostic test which could be easily implemented in decentralized levels of care. Given the impact of the COVID-19 pandemic on TB notifications at the three participating sites and on several STool4TB core activities, we request additional funding to finalize recruitment of participants and achieve the target sample size, ensuring full execution of all project’s objectives. The observed upward trend in global TB burden makes the development of promising diagnostic tools, such as this novel stool-based qPCR, more important than ever.