Naturally, locating and treating infected immigrants is a challenge, especially if they are unaware that they're carrying the disease. Immigrants who apply for visas or green cards receive automatic screening for TB, but that still leaves an unidentified number of illegal entrants who never get tested. Other at-risk individuals, such as the homeless, are difficult to track for appropriate evaluation. The TB testa skin prick and subsequent "reading" of the injection point three days latercan be ineffective at shelters and free clinics that deal with such a transient population. The global spread of HIV/AIDS has been perhaps the biggest perpetuator of TB, and the primary contributor to the disease's resurgence since the 1990s. By depleting the body's immune system, HIV/AIDS clears the way for the mycobacteria to wreak havoc. "[AIDS has] just been gasoline on the firea pervasively difficult problem to address with available medical means," Dr. Iseman says. "It scares you witless, because what are we going to do? Change sexual behavior? I don't think so."
Researching new drugs to counter these emerging strains of drug-resistant TB is a priority at CSU. Unfortunately, progress is slow-going. The university has received $95 million over the last 15 years to fund TB research, including a recent prestigious $1.1 million Gates Foundation grant to study the effectiveness of TB testing systems. Nevertheless, a truly innovative drug hasn't been developed since the 1960s.
Part of the problem, says Dr. John Belisle, director of CSU's Microbacteria Research Lab, is the lack of interest from pharmaceutical companies. Since the majority of TB cases happen in developing countries, most patients can't afford drugs, which means there's no incentive for drug companies to sink research dollars into the product. It's far more likely for a pharmaceutical corporation to fund drugs that treat conditions prevalent in affluent societies. Though he's optimistic about CSU's research prospects, his expectations are pragmatic. "It's an issue of control versus elimination," he says. "TB is not a disease we're going to easily eliminate, even from a population that's reasonably healthy."
Federal legislative efforts on TB drug development also have stalled, largely because TB is still a stigmatized disease that lacks active political advocacy. "The real bottleneck is in clinical research," says Dr. Randall Reves, director of the Denver Metro Tuberculosis Control Program. Even if a promising new drug emerges, it takes years of additional clinical trials on infected volunteer patients before the treatment can hit the market. Federal legislators introduced the Comprehensive Tuberculosis Elimination Act last summer to address this problem, but Reves, who testified in support of the bill at a committee hearing last October, ran into senatorial opposition to mandates that were so disease-specific.
Margaret Freedman, now 23, finished her treatment at the end of 2006 and has graduated from nursing school. She only occasionally experiences mild pain from scar tissue. Last summer, a 19-year-old girl in Colorado Springs wasn't so lucky: The CSU-Pueblo student from Nepal died of TB shortly after arriving at the Memorial Hospital emergency room. Freedman says she's grateful to have received such high-quality care at Denver Health. She knows that the man on the bus in Kenya probably has yet to receive treatment, if he hasn't already succumbed to the disease. But her experience won't keep her from going back. "I gained a lot of respect for the diseasea knowledge and awareness. My senses are heightened because of it," she says. "I have a huge passion for Africa. I want to live there and do nursing someday. I'm not going to let the fear of TB keep me from doing that."