Although 95% of the global population of patients with TB still qualify for first-line therapy, namely treatment with isoniazid, rifampicin, ethambutol and pyrazinamide, the number of patients with multi-drug resistant TB (MDR-TB) has been growing as a proportion of total incidence.

Seeking to understand how patients get MDR-TB, he is performing pathogen whole genome sequencing for a comparative genomic analysis of the burden of MDR-TB transmission, and at the same time, seeking to understand the contribution of different factors related to the de novo emergence of resistance to first-line drugs. To this end, two case-control studies are assessing potential selection pressures, including undiagnosed resistance to other drugs and pharmacogenomic and pharmacokinetic factors.

These studies will help us understand how we best preserve the efficacy of what is still our most effective and shortest treatment regimen for any kind of TB. Depending on the findings, potential interventions will include broader-ranging and more precise diagnostic approaches, more personalised drug dosing, or more focus on community-based public health measures.