To address shortfalls in TB screening and prevention in low-income countries, the Mérieux Foundation’s commitment in the field focuses on identifying, transferring and assessing diagnostic innovations that allow the identification of new cases, improvements in treatment, and prevent the spread of the disease. This intervention is carried out within the framework of the WHO’s END-TB strategy via multiple collaborations with the health authorities in each country, research institutes, industry, and local civil society organizations involved in community programs.

The Mérieux Foundation has made combating tuberculosis one of its priority areas of intervention, with eleven projects carried out in ten or so countries in 2023. The Foundation supports national TB control programs with implementing the WHO’s recommendations. The objective is to improve the diagnosis and treatment of the disease in the most vulnerable populations, with two main areas of intervention:

• Reinforce capacities for diagnosis and surveillance, in particular via the GABRIEL network (22 members, including nine Rodolphe Mérieux Laboratories in Bangladesh, Brazil, China, Haiti, Laos, Lebanon, Madagascar, and Mali). In Lebanon, for example, the Rodolphe Mérieux Laboratory in Beirut has been appointed the national reference laboratory for TB.
• Facilitate access to innovative diagnosis methods, with operational research projects aiming to evaluate the tests under real-life conditions in order to improve the prevention and treatment of the disease in all its forms. The HINTT multicentric study conducted since 2017 by five members of the GABRIEL network (Bangladesh, Georgia, Lebanon, Madagascar, and Paraguay) led to the identification of two blood tests that could improve the diagnosis and treatment of TB.

Operational research is a priority

Tuberculosis presents multiple challenges in that there is no effective vaccine and no rapid, portable, reliable, and non-invasive test for the disease. To help fulfill the need to improve diagnosis techniques, the Foundation’s research projects are pursuing three objectives:

• Prevention, of both the transmission and evolution of the disease in infected individuals, with projects aiming to assess the positioning and performance of tests allowing the identification of people with a silent form of infection associated with an increased risk of developing an active form of the disease. The APRECIT project, carried out in Cameroon and Madagascar since 2020, assesses the pertinence of a large-scale screening strategy involving community intervention, training in carrying out tests, and the treatment of TB sufferers and contact cases. Since 2022, APRECIT-BIS has been evaluating the performance of two blood tests for screening for TB infection and identifying more precisely those who may benefit from preventive treatment.
• Diagnosis of complex forms: pediatric tuberculosis (need for an alternative to sputum-based tests), extra-pulmonary tuberculosis, and forms that are resistant to TB medication. In Bangladesh, the DEDICATE project is evaluating a new method of diagnostic blood testing in children and the EBC-LAM program launched in 2023 covers the evaluation of a rapid and non-invasive breath test for adults and children.
• Epidemiological surveillance of resistant forms of TB. In Laos, the DiLAO-TB project is currently studying the feasibility of incorporating modern technologies for the genome sequencing of mycobacteria to rapidly characterize the level of resistance to antibiotics of strains of Mycobacterium tuberculosis. These tools could support Reference Laboratories for TB with epidemiological surveillance at national level.

An integrated approach

TB control is a public health priority in the countries in which the Foundation operates, and all areas of the Foundation are involved in diagnosis, interventional research in the field, and knowledge sharing. Since 2020, these activities have expanded considerably across all areas of intervention, through multiple local, national, and international collaborations. With a reputation for expertise and community intervention, the Mérieux Foundation works in synergy with the global ecosystem for combating the disease. It has made an important contribution to USAID’s Infectious Disease Detection and Surveillance project (IDDS program 2019–2024).

Experts from the Foundation monitor technological developments to identify any diagnostic solutions under development that might provide reliable screening solutions, working alongside industrialists in the sector and reputable international research teams in the field of tuberculosis. This is how the miniaturized blood test was identified, currently the subject of a pediatric study in Bangladesh (DEDICATE program).

In 2023, the Foundation joined the Stop TB Partnership, an international consortium of parties involved in the fight against TB and communities affected by the disease. The Foundation is also a partner of The Union, a global organization fighting tuberculosis and lung diseases, and participated in its conference in Paris from November 15 to 18, 2023, the most important event on respiratory infections in the world.