Tuberculosis (TB) is one of the most deadly infectious diseases in the world. 

Obsolete treatments, the lack of an effective vaccine, and the lack of suitable diagnostic tools make it difficult to control the global TB epidemic. Some gains have been made in recent years but the harsh reality remains—according to the World Health Organization 10 million people fell sick with TB in 2019, over 200,000 people developed drug-resistant TB (DR-TB), which is much harder to treat, and 1.4 million people died from TB. The majority of people with TB go undiagnosed and therefore untreated. 

What is tuberculosis?

TB is often thought of as a disease of the past, but a recent resurgence and the spread of drug-resistant forms makes it very much an issue of the present day and age.

TB is caused by a bacterium (Mycobacterium tuberculosis) that is spread through the air when infected people cough or sneeze.

The disease most often affects the lungs but it can infect any part of the body, including the bones and the nervous system. TB symptoms include a persistent cough, fever, weight loss, chest pain, and breathlessness 

How is tuberculosis spread?

Most people who are exposed to TB never develop symptoms, since the bacteria can live in an inactive form in the body, but if the immune system weakens, such as in malnourished people, people with HIV or the elderly, TB bacteria can become active. 

Around 5-10 percent of people infected with TB will develop active TB and become contagious at some point in their lives. 

How is tuberculosis diagnosed?

The most widely-used TB test relies on examining a patient’s phlegm under a microscope. This method, developed over a century ago, detects less than half of all TB cases and largely fails to detect the disease in children and people co-infected with HIV and those with forms of DR-TB. More recently a rapid test, Xpert MTB/RIF, was developed to diagnose TB and we use it in many of our projects, but it is difficult to use in resource-limited settings. 

How is TB treated?

TB is a treatable and curable disease, however a course of treatment for uncomplicated TB takes a minimum of six months. 

It is important that a patient completes their entire course of treatment even when they start to feel better, because incomplete treatment can lead to them developing drug resistance. We are currently seeing an alarming rise in cases of DR-TB and multidrug-resistant TB (MDR-TB) that do not respond to the customary first-line drugs. 

What is drug-resistant tuberculosis (DR-TB)?

When patients are resistant to the two most powerful first-line antibiotics (rifampicin and isoniazid), they are considered to have MDR-TB. Treatment is long and arduous, with the drugs having many potential side-effects including psychosis and deafness. People can take as many as 20 pills a day for two years, only to face a cure rate of little better than one person in two. Extensively drug-resistant TB (XDR-TB) occurs when a patient is resistant to second-line drugs. The treatments for XDR-TB are limited. 

How is MSF helping tuberculosis patients? 

MSF has been fighting TB for over 30 years. We provide treatment for the disease in many countries including Ukraine, Uzbekistan, South Africa, India, Libya and Papua New Guinea. 

In many places where we work, supervising all TB patients during their prolonged treatment is difficult.  

Wherever possible, MSF chooses to use the most effective medicines, treatment and approaches to care that put people at the centre. That’s because they significantly increase the chance that a person can be cured. 

We strive to: 
  • accurately diagnose tuberculosis and determine what type the patient has
  • find the drugs that are most effective 
  • design the right treatment using newer, more effective medicines 
  • help people get drugs and tests on time
  • provide supportive care for as long as treatment is needed.

To help patients complete their treatment, MSF has introduced more flexible strategies to deliver TB treatment. For example, in Uzbekistan, instead of traditional regular nurse visits to a patient’s home, MSF provides video directly observed treatment, or V-DOT. Patients say it is not only more convenient, but that it provides more confidentiality. 

“It was always challenging for me when the nurse arrived at my home. I was worried that my neighbours would spread gossip. When I was offered V-DOT, I was happy to accept it. I take my drugs early in the morning, do my household chores and I don’t have to worry about any gossip, as this mode of treatment ensures full confidentiality.”

Nineteen-year-old TB patient
Karakalpakstan, Uzbekistan

In Libya, patients with TB often come from a poorer background, living in crowded, poorly ventilated accommodation and missing out on adequate nutrition, which can increase the risk of developing TB. TB is an expensive disease to diagnose, and many people cannot afford the tests and develop complications because they do not receive treatment in time. MSF covers the costs for the patients who cannot afford the tests and the treatment. 


An MSF doctor interpreting the chest x-ray of a patient with multidrug-resistant TB (MDR-TB). © Atul Loke

Tuberculosis in children 

Children have a high risk of TB infection, progressing to active TB and developing a severe form of the disease. 

In many places children are not able to receive the most effective TB medications, including newer drugs like bedaquiline and delamanid, because they were not included in studies of these lifesaving treatments. Instead, they are given old, often toxic, medications, which come as adult-sized tablets that have to be cut, crushed and mixed before they can be given to children. In the worst instances, children are still treated with a daily injection, even though there are more effective oral options. These injections are not only extremely painful—as a side-effect the drug also puts their hearing at risk irreversibly, a devastating complication for a developing child.  

MSF is addressing these issues in our projects in South Africa and India. We are screening all children and adolescents in a household where someone has been newly diagnosed and piloting the use of stool samples, rather than intrusive gastric washing, to test whether children have TB. We’re conducting the pilot in hospitals as well as in the community. 


A 10 year-old girl with XDR-TB who was cured with the bedaquiline and delamanid-based DR-TB treatment regimen in MSF’s independent TB clinic, Mumbai, India. © Atul Loke

Better treatment for TB patients 

In the effort to find short and effective treatments for people with DR-TB, MSF has been contributing to a cutting-edge, multi-country clinical research project with the London School of Hygiene and Tropical Medicine and other global leaders in medical research.  

The results have been very positive and MSF believes these findings will have the potential to change clinical practice. 

“The findings could transform the way we treat patients with drug-resistant forms of TB worldwide, who have been neglected for too long.”

Professor David Moore
TB-Practecal Trial Steering Committee Member

What can I do?