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There may be seven new drugs in the pipeline, but the global control and treatment of tuberculosis (TB) still faces many challenges, warn Ann Ginsberg and Melvin Spigelman in this Nature Medicine article.

TB is not well controlled, particularly in parts of the world with limited public health infrastructure, high HIV prevalence or both. This is in part due to the lengthy and complicated nature of first-line TB treatment — and failure to adhere to this drives drug resistance.

The primary goals of global TB research are to shorten treatment time, provide safer and more effective treatment for drug-resistant TB and simplify treatments for people with both HIV and TB.

This will require a well-fed drug pipeline supported by more research into the underlying mechanisms of TB's action in the body, as well as the creation of new animal models, say Ginsberg and Spigelman.

Drug interactions must be studied by testing TB drugs in combination, and late-stage clinical trials should be conducted in low- to middle-income countries where the majority of patients live.

The authors warn that a lack of TB research over the last 30–40 years means few places have experience of handling clinical trials correctly. Significant capacity building will be necessary at a number of sites throughout the world.

Link to full article in Nature Medicine