Description

HORIZON-JU-GH-EDCTP3-2026-01-TB-01-two-stage

Expected impact

The actions funded under this topic should contribute to achieve the reduction of disease burden in SSA through increased international cooperation among researchers and funders, catalyse research synergies, and leverage resources and investment.

Proposals are expected to include the effective in-kind and/or financial contribution of contributing partners, in order to produce more meaningful and significant effects enhancing the impact of the related research activities.

Background

Tuberculosis (TB) remains a prominent global health challenge. According to the WHO’s Global TB Report 2024, the global rise in the number of TB incident cases, likely as effect of the disruption of TB services during the COVID-19 pandemics, has slowed and started to stabilise. The total number of people infected with TB was 10,8 million in 2023, a small increase from 10,7 million in 2022 although still much higher than 10,4 million in 2021 and 10,1 million in 2020. Globally, 80% of the number of deaths by TB occurred in the WHO African and South-East Asia regions, with 16 out of 30 countries located in sub-Saharan Africa (SSA). Most of the TB deaths among people with HIV occurred in the African Region. Adolescents and adults account for over 80% of the TB burden and are the main source of transmission, including transmission to children.

Millions of people affected by TB are missing out on quality care each year, including on access to affordable diagnostic tests and treatment, especially in low- and middle-income countries. TB affects populations inequitably and contributes to the cycle of ill health and poverty, with malnutrition currently being the most prevalent contributor to the incidence of TB and inadequate living conditions contributing to the spread of M. tuberculosis and its impact on the community. Investments in building robust, integrated, and resilient health systems, including in TB prevention, detection and treatment services and research and development infrastructure and community responses can advance universal health coverage and contribute to effective prevention and response. It is urgent to scale up comprehensive efforts to close long-standing gaps in prevention, diagnosis, treatment, and care of people at risk of TB, including children and immune-compromised individuals.

In terms of TB research and innovation, the following fields should be prioritised for TB drugs for therapy, chemoprevention or chemoprophylaxis according to the WHO Global TB Report 2024: new preventive drug treatments to prevent the progression to TB disease including patients with latent TB infection, and simpler, shorter treatments for TB disease.

Ongoing TB therapeutics trials are targeting particularly multidrug-resistant tuberculosis (MDR-TB), exploring promising agents as well as the potential of host-directed therapies. Various combination regimens with new or repurposed drugs, as well as host-directed therapies, are in Phase II or Phase III/IV trials. In Phase II, more than 25 trials are ongoing mainly addressing new drugs, shorter therapeutics regimens, MDR-TB and extensively-drug resistant TB (XDR-TB), and novel combinations. Several other challenges including long treatment regimens and adverse side effects need to be addressed.

TB and leprosy are both caused by mycobacteria being Mycobacterium tuberculosis and M. leprae respectively and share similar challenges related to transmission, diagnosis, and prevention in (co-) endemic settings. Post-Exposure Prophylaxis (PEP) has emerged as a promising intervention to prevent disease progression in individuals at risk due to potential infection, particularly in close contacts. Recognising the often-overlapping endemic areas, needs, tools and approaches in TB and leprosy prevention, intervention studies are needed of integrated approaches that may offer an efficient way to address both diseases simultaneously. Several promising TB drugs have also shown activity against Mycobacterium leprae, showing potential for a unified PEP strategy preventing both diseases.

Expected Outcome

The proposals submitted under this topic should aim to deliver results that are directed, tailored towards and contributing to improve TB-related outcomes in adults, and/or children in SSA.

In addition, proposals are also expected to lead to reduced burden of disease related to MDR-TB and XDR-TB and/or improved TB interventions in the most vulnerable populations, particularly children.