Abstract

PIP: Tuberculosis (TB) is reemerging as a major public health problem worldwide. The emergence of multidrug resistance and the interaction between TB and HIV infection are responsible for this surge. Immunologists, epidemiologists, economists, clinicians, policymakers, and heads of TB control programs attended a 1993 public health conference called Tuberculosis--Back to the Future, at the London School of Hygiene and Tropical Medicine. They agreed that urgent research is needed on diagnostics, new drugs, vaccines, and control strategies to address the reemergence of TB. They also called for a much higher investment in existing cost effective methods for TB control. Research scientists and staff of national TB control programs must work closely together to assure success of any strategy. Before the HIV epidemic, the risk of TB infection in developing countries fell 1-5% per year. The HIV epidemic has reversed this trend. It also fell in developed countries. In the US, the risk began to increase in 1986 in New York City due to increased immigration from TB endemic countries, interaction between TB and HIV, and decay in the health infrastructure supporting TB control programs. Treatment failures or relapses due to disorganized treatment programs account for most multidrug resistance in the US as well as in other countries. Research areas of diagnostics improvement include clinical evaluation, microscopy, culture, and radiographic examination. Drug research areas are in new drugs to improve patient compliance; investigation of the mechanism of virulence of Mycobacterium tuberculosis to understand mycobacterial persistence, thus helping in the development of new drugs; and operations research of rational use of drugs by clinicians. Vaccine research is perhaps the most important research, especially since the current vaccine is not always effective. TB control program and operational issues include case finding and treatment, chemoprophylaxis, treatment regimens, operational research, supervision, and drug supply.