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Host-Directed Therapies
The current status quo of the lengthy treatment duration and poor treatment outcomes associated with MDR/XDR-TB, and those with co-morbidity of TB with HIV and NCDs, in sub-Saharan Africa is unacceptable [1-5]. New innovations for shortening duration of therapy, improving treatment outcomes, preventing relapse, reducing drug resistance, and preventing long term lung damage, are urgently required [2,3,6]. The TB drug pipeline remains sparse [4,6]. A broad of range of Host Directed Therapies (HDT) now provide hope for improving treatment outcomes and reducing duration of therapy [7-15]. These require evaluation in randomized, placebo-controlled clinical trials (RCTs) as adjuncts to current TB treatment regimens. The objectives of HDT-NET are:1. To evaluate in RCTs a range of Adjunct Host Directed Therapies (see list) for:a). Shortening duration of treatment for:i). drug sensitive TB (DS-TB).ii). multi-/extensively drug resistant TB (MDR-TB/XDR-TB).b). Improving treatment outcomes (mortality/morbidity) for MDR/XDR-TB patients.c). Improving treatment outcomes for specific clinical conditions associated with tissue injury:i). HIV co-infected individuals with DS-TB and MDR/XDR-TB. ii). TB pericarditis.iii).Miliary TB and TB meningitis.iv).TB-associated Immune Reconstitution inflammatory syndrome (IRIS).d). Preventing recurrence of TB or relapse or TB drug resistance.e). Reducing excessive lung inflammation and preventing long term lung matrix destructionand complications.f). Improving treatment outcomes of people with co-morbidities such as NCDs (eg diabetes, COAD, any cancers, NIDs. This will create a more holistic approach for high quality care.
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