(Boston)—Tuberculosis (TB) has regained its place as the leading infectious killer worldwide. Annually, 1.6 million people die of this disease which is the equivalent to three TB deaths per minute. While the TB pandemic is driven by five key risk factors – undernutrition, HIV, alcohol use, tobacco use and diabetes – the extent of mismatch between their impact on TB and available research funding is unclear.
Researchers at Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center (BMC) have found that research on key TB risk factors, like undernutrition, is underfunded, especially when their relative impacts are considered.
"While HIV is a key driver of the TB pandemic, particularly in Africa, inattention to other risk factors is damaging to global TB elimination efforts. Indeed, undernutrition, which accounts for at least one in five cases of TB world-wide, received a small fraction of research funding accorded to HIV-TB in 2018-2019 ($1.2 million for TB-undernutrition vs. $87.6 million for TB-HIV)," explains corresponding author Madeline Carwile, a TB research assistant at BMC. "Systematically quantifying the mismatch, which we have done in this study, can help us advocate for increasing NIH funding for other key TB risk factors and realize the goals of TB elimination programs through scientific discovery."
The researchers systematically reviewed NIH RePORTER (the website listing all projects funded by the NIH) to compare research funding for key TB comorbidities: undernutrition, alcohol use, HIV, tobacco use and diabetes. Abstracts were reviewed for each comorbidity over a ten-year funding period that included the project title, category, description and funding amount. Funding for each comorbidity was then compared to the number of TB cases attributable to each risk factor.
TB is the leading infectious cause of death globally and is one of the top global health priorities, according to researchers. "Addressing TB requires strategic health and research investments which will help us develop interventions that can curb the TB pandemic," says co-senior author Pranay Sinha, MD, assistant professor of medicine at the school and an infectious disease physician at BMC. "To develop a more holistic approach to the management of TB, which incorporates integration of care for key comorbidities such as tobacco use, alcohol use, diabetes, and undernutrition, we need more translational, clinical and implementation research."
The researchers believe their data can serve as advocacy tools to urge policymakers and funders to diversify their research investments and allocate more research funding to currently underfunded risk factors.
These finding appear online in Open Forum Infectious Diseases.
Funding was provided by the Warren Alpert Foundation [grant number 6005415], the Burroughs Wellcome Fund / American Society for Tropical Medicine and Hygiene, the National Institute of Allergy and Infectious Diseases [grant number 5T32 AI-052074-13 and K01AI167733-01A1 to PS], the Civilian Research and Development Foundation [grant number DAA3-19-65673-1], as well as federal funds from the Government of India's Department of Biotechnology and the Indian Council of Medical Research, and a career investment award from the Department of Medicine at the Boston University Chobanian & Avedisian School of Medicine.
