Grant: Catalyst Grant: Ethics

In 2012, approximately 1.25 million people globally died from tuberculosis (TB) and multidrug resistant tuberculosis (MDR-TB), most of who were of lower socioeconomic status (SES) and lived in low and middle-income countries (LMICs). In particular, tackling TB in countries like South Africa has been difficult given the high prevalence of co-morbidity between HIV/AIDS and TB. New technologies have been developed to help practitioners prevent, diagnose, and treat TB across the globe. However, new antitubercular drugs (i.e., bedaquilin, delamaind) have serious side effects, while new diagnostics (i.e., Xpert MDR/RIF) raise the specter of diagnosing more patients than can be treated in LMICs. Given the current uncertainty surrounding TB, policy makers, healthcare workers, and patients are required to balance the risks and benefits of new research, prevention, and treatment techniques with incomplete or suboptimal information, which requires normative judgments as to what is and is not worth risking, for what, and for how much. To date, a robust ethical analysis of risk and benefit in the context of new TB research, prevention, and treatment is lacking. There are no studies that link the perspectives of policy makers, bench scientists, and healthcare workers with a philosophical informed analysis of ethical issues related to TB care. This project proposes to address this knowledge gap and provide policy and practice recommendations. The concepts of reciprocity and solidarity will be evaluated to see whether they could potentially help guide risk-benefit analysis for TB care by taking into account the perspectives of key stakeholders. We will conduct a philosophical analysis of the risks and benefits of new technologies for TB, coupled with qualitative interviews of policy makers, bench scientists, and healthcare workers in South Africa, the World Health Organization, and the Bill and Melinda Gates Foundation.