World Tuberculosis Day: we must make tuberculosis treatment shorter, more effective and cheaper
Godfrey Ombogo*
It’s today [le 24 mars] World Tuberculosis Day, and this year’s theme is ” Yes ! We can end TB ».
Tuberculosis is the deadliest infectious disease in the world and only recently moved into second place, behind Covid-19.
Tuberculosis treatment is also expensive, but efforts are being made to reduce treatment costs.
Doctors Without Borders (MSF) launched two clinical trials aimed at finding shorter, better tolerated and injection-free treatments for the multidrug-resistant tuberculosis (TB-MR).
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A patient with multidrug-resistant tuberculosis in Karakalpakstan, Uzbekistan shows her daily dose of anti-tuberculosis drugs as part of a short course of treatment. [Médecins Sans Frontières]
Attempts endTB et endTB-Q aim to develop a treatment regimen to treat multidrug-resistant tuberculosis in six to nine months, compared to the current 24 months.
The test endTB focuses on multidrug-resistant tuberculosis susceptible to fluoroquinolonewhile the test endTB-Q focuses on fluoroquinolone-resistant multidrug-resistant tuberculosis.
10.6 million people fell ill with TB in 2021 – a 4.5 percent increase from 2020 – while the incidence rate increased by 3.6 percent between 2020 and 2021, after declines of two percent per year over the previous two decades.
MSF claims that conventional treatments for multidrug-resistant tuberculosis are ineffective, with only 59% treatment success reported in 2018, and that they often cause terrible side effects, including acute psychoses and permanent deafness.
During this time, patients swallow up to 14,000 pills and some of them endure months of painful daily injections.
Furthermore, the cost, difficulty and duration of current treatments make them difficult to implement in many high-burden countries.
In December 2022, theWorld Health Organization (OMS) a published new guidelines recommending that countries implement the regime BPaLMsafer and shorter, to treat people with drug-resistant tuberculosis.
We need better access to diagnostic testing for TB and drug resistance used to treat TB so that we can identify more people who need treatment and roll out the shorter oral treatment regimens and safer.
Mr. Stijn Deborggraeve, Diagnostic Advisor at Access Campaignnow urges countries to start rolling out the regime BPaLM of six months and to guarantee the availability of tests GeneXpert MTB/RIF or, if possible, alternatives recommended by theOMS such as the Thunder MTB/RIFto detect tuberculosis and resistance to rifampin so that people with drug-resistant tuberculosis can receive this treatment without further delay.
« We need better access to diagnostic testing for TB and drug resistance used to treat TB so that we can identify more people who need treatment and roll out the shorter oral treatment regimens and safer said Mr. Deborggraeve.
As World Tuberculosis Day is celebrated today, March 24, there is growing concern about the resurgence of this infectious disease and the concerted efforts needed to end it.
L’OMS estimated that 10.6 million people fell ill with TB in 2021 – a 4.5 percent increase from 2020 – while the incidence rate increased by 3.6 percent between 2020 and 2021, after declines of two percent per year over the previous two decades.
Kenya is among the high TB burden countries and is on the list of 30 countries that contribute 80% of the global TB burden.
The statistics of GlobalData show that over the past ten years, 668 clinical trials for tuberculosis treatments have been launched, almost 30% of them since 2020.
The tests carried out by MSF are made in partnership with Partners In Health (PIH) et Interactive Research and Development (IRD).
The other partners are Epicentrethe Harvard Medical Schooll’Antwerp Institute of Tropical Medicine and theUCSF.
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A tuberculosis patient in South Africa holds his medicine. He takes up to 26 pills a day to treat extensively drug-resistant tuberculosis. Here he holds his morning selection, which includes delamanid, one of the newest drugs for drug-resistant tuberculosis. [Médecins Sans Frontières]
The test endTB enrolled 754 patients in eight countries – Georgia, India, Kazakhstan, Lesotho, Pakistan, Peru and South Africa – all of whom have a high burden of TB, as of October 2021.
On the other hand, the clinical trial endTB-Q is expected to recruit 324 patients in six countries (India, Kazakhstan, Lesotho, Pakistan, Peru and Vietnam) to find a simpler, less toxic and shorter treatment for fluoroquinolone-resistant multidrug-resistant tuberculosis.
Governments, donors and pharmaceutical companies must act now to ensure an affordable supply of these essential TB tests and treatments, so that more lives can be saved.
As of January 2023, some 294 participants were enrolled in the trial, and recruitment is expected to end in the first quarter of this year.
As testing continues, MSF also calls for the reduction of the prices of medicines and tests in order to make them more accessible.
« We once again call on Cepheid reduce the price of TB tests to less than $5 apiece, so that more people with drug-resistant TB can be diagnosed in time and offered improved treatments that will save their lives says Deborggraeve.
According to him, national tuberculosis treatment programs should offer shorter treatment regimens to more people in order to increase demand, and ensure that more manufacturers provide affordable generic versions of there bedaquiline and pretomanid. The lowest price available for this new TB treatment is $570.
« Access to affordable diagnostic tests remains a major challenge in Afghanistan and other countries in the region due to the high price of the tests. Governments, donors and pharmaceutical companies must act now to ensure an affordable supply of these essential TB tests and treatments, so that more lives can be saved. »
Kenya has seen significant progress in controlling the disease and a dramatic drop in TB-related deaths from 33,000 in 2019 to 21,000 in 2021.
Ms. Evaline Kibuchi, Public Health Advocate and Chief National Coordinator of the Stop TB-Kenya Partnershipsays TB remains a public health threat in Kenya.
« In 2021, approximately 1.6 million people died of tuberculosis worldwide. Kenya is one of the countries where the TB burden is high and is on the list of 30 countries that contribute 80% of the global TB burden. »
« In Africa, Kenya ranks fourth after South Africa, Nigeria and Ethiopia, in that order. Even with such a ranking, Kenya has made great strides in tackling the disease and there has been a dramatic drop in TB-related deaths from 33,000 in 2019 to 21,000 in 2021, according to the latest global report from theOMS on tuberculosis. »
Ms Kibuchi said that although Kenya has made great progress, around 50% of all people infected with TB go undiagnosed.
« This poses a great danger, because these people infect other people “, she adds.
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