A step backwards

Nurses in the UK criticise use of 115-year-old test to detect latent TB

Almost three-quarters (70 per cent) of TB nurses in the UK think that the introduction of the Mantoux tuberculin skin test (TST) for detecting latent TB infection is a step backwards, while a third believe it is a major setback in the fight against the disease, according to a survey.

The TB Nurses Survey, carried out in November 2005, also revealed that over half the nurses do not use the skin test because they think the results would be incorrect.

Yet, the 115-year-old Mantoux test has been recommended by the National Institute for Health and Clinical Excellence (NICE) as a first line test for latent TB (which has no symptoms and is not infectious, although it does have the potential to develop into TB at any time) with provision to carry out a blood test if the skin test is positive.

NICE has recommended the blood test as a first line diagnostic tool for latent TB only in immunosuppressed individuals, but not for general use in the UK. T-SPOT.TB, an in vitro T cell measurement test, produced by Oxford Immunotec, is said to be the first reliable diagnostic tool for detecting TB in those who are immunosuppressed.

Some 82 per cent of the nurses that took part in the survey said that the blood test should be used across the UK, while 95 per cent of these said they would choose it as standard practice for TB diagnosis.

The guidance from NICE follows recommendations from the US Centers for Disease Control and Prevention (CDC), as part of its new TB detection guidelines, for a one-step blood test to be used in all diagnoses of TB.

Treatment initiatives
Fears over the diagnosis of TB and its resurgence in the developing world have signalled an increase in funding for the disease and its treatment.

Eli Lilly & Co, with leading global health and relief organisations, is launching initiatives to tackle the human resource issue surrounding the treatment of TB.

They are calling for governments to commit to fund, train and increase the healthcare workforce to combat TB, the increase in drug-resistant strains of TB (MDR-TB) and reduce the daily death toll which currently stands at 5,000.

The US-headquartered pharma firm has pledged a £40.3m ($70m) investment to a new global partnership to fight MDR-TB.

Lilly MDR-TB Partnership is a public-private initiative involving the pharma company and 13 other participants.

Although 90 per cent of the world's population live in countries that have adopted internationally accepted strategies for the treatment of TB, there is a shortage of adequately trained healthcare workers to fully implement the control programmes, which could save 14 million lives over the next decade.

The successful treatment and prevention of this silent killer is, above all, dependent on sufficient well-trained, mobilised and motivated health providers, particularly for multi-drug resistant tuberculosis, said Rich Pilnik, Lilly president of Europe, Africa, Middle East and the CIS.

According to the Stop TB Partnership, it is estimated that $250m is needed each year to provide technical assistance to give training to health workers and boost TB control services.

The launch of the initiative follows the announcement of the Global Plan to Stop TB 2006-2015 at the Annual Meeting of the World Economic Forum in Davos, which aims to raise awareness of the re-emergence of the disease.

For information on Lilly MDR-TB and the organisations taking part, visit www.lillymdr-tb.com