Preventing Tuberculosis​

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We are evaluating novel vaccines, and better tolerated therapies to prevent tuberculosis.

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Clinical trials of new therapies for drug-susceptible and drug-resistant TB infection

 

One in 10 people infected with M. tuberculosis progress to TB disease. Preventive therapies given soon after infection have been shown to reduce subsequent TB incidence by around two-thirds. However, uptake is poor and discontinuation frequent (up to 25%) due to intolerance and the prolonged duration (3-9 months) of WHO-endorsed therapies. We aim to identify the safest and best-tolerated TPT regimens with adequate efficacy against infection with drug-susceptible and drug-resistant strains.

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Evaluating community-wide ‘testing and treatment’ of TB infection

 

Around a quarter of the world’s population has M. tuberculosis infection, with 10% developing active TB disease. In Australia, most cases occur in migrants from high-burden settings, making latent TB treatment a key focus. While screening and TPT are recommended for high-risk groups, uptake remains very low (<5%). Our studies in Vietnam, PNG, and Kiribati show mass ‘testing and treatment’ for TB infection is feasible, but its effectiveness is unproven, and ethical concerns remain for low-risk individuals. We aim to demonstrate the feasibility, scalability, and impact of community-wide TB infection 'test and treat' approaches, and conduct consumer-led research to identify the most acceptable testing and treatment approaches in different contexts.

 

​​​Development and evaluation of new vaccines against M. tuberculosis

 

Vaccinations are often the most cost-effective way to prevent infectious diseases, reducing the need for antibiotics and slowing the emergence of resistance. However, the only approved TB vaccine, M. bovis BCG, offers limited protection. While the promising M72/AS01 candidate showed ~50% protection in Phase 2B trials and is advancing to Phase 3 with support from the Welcome Trust and Gates Foundation, more vaccine candidates with diverse modes of action are needed to improve efficacy, breadth, and reduce the global TB burden. We aim to develop promising new TB vaccine candidates with evidence of immune protection and safety, and evaluate the effectiveness of novel vaccines in human trials.

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​​Optimising TB infection management and prevention in Australia

 

Around 90% of people developing TB in Australia were born in high-incidence settings, with the highest risk occurring within the first two years after arrival. To address this, Australia has implemented stringent offshore TB screening, including infection testing for children under 12 (2017) and healthcare workers (2022), with plans for future expansion. Monitoring and evaluating these programs is essential to ensure their burden and benefits are balanced. Whole genome sequencing (WGS) has revolutionized TB microbiology, enabling identification of transmission clusters and drug-resistance profiles, and new methods allow direct sequencing from sputum for early targeted treatment. Australia is a global leader in using WGS for precision public health, achieving accurate transmission tracking and adopting ‘zero local TB transmission’ as a national strategic priority. We aim to monitor and evaluate the expansion of TB infection testing and treatment in Australia, identify optimal models of care for TB infection management and evaluate its cost-effectiveness, and utilize routine whole genome sequencing (WGS) as a critical tool for epidemic control.

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