India accounts for more than 28% of the global burden of TB and more than 26% of total multi-drug resistant TB cases
In high TB-burden countries including India, the availability of a six-month all-oral regimen for the treatment of people with drug-resistant TB can be a game changer. Photo: WHO. As countries get ready to commemorate World Tuberculosis Day on March 24, the World Health Organization (WHO) and civil society groups urge them to update treatment guidelines at the earliest. In December 2022, the global health body issued guidelines for rolling out a safer and shorter treatment regimen for people suffering from drug-resistant tuberculosis (DR-TB).
Read more: India reports sharp decline in tuberculosis registration after COVID-19 lockdown
WHO’s guidelines recommended that countries roll out the safer and shorter BPaLM regimen (comprising bedaquiline, pretomanid, linezolid and moxifloxacin) to treat people with DR-TB.
This update would be crucial for India, which accounts for more than 26 per cent of total multi-drug resistant TB (MDR-TB) cases. The Global Tuberculosis Report 2022 pointed out that of the 0.45 million MDR-TB cases globally, India reported 119,000 cases. The country accounts for more than 28 per cent of the global burden of TB — some three million of the total 10.6 million cases.
India is yet to update the Guidelines for Programmatic Management of Drug-Resistant Tuberculosis, which were last revised in 2021.
“In high TB-burden countries including India, the availability of a six-month all-oral regimen for the treatment of people with DR-TB can be a game changer in ensuring that more patients can start and complete treatment sooner, with better outcomes and lesser side-effects,” said Animesh Sinha, HIV/TB/Hepatitis advisor at Médecins Sans Frontières/Doctors Without Borders (MSF) UK.
Increasing access to the treatment also requires that diagnostic tests are available more easily. The GeneXpert MTB/RIF test made by US corporation Cepheid is the most common diagnostic test used to detect resistance to the first-line drug rifampicin.
Read more: Tobacco consumption rising among Indian TB patients: India TB 2020 report
Though the production cost for a test is less than $5, Cepheid sells it for nearly double the price, at $9.98, an analysis by the global humanitarian organisation MSF showed. MSF has also urged Cepheid to lower the price of the critical GeneXpert tests.
The recommendations to test and quick treatment comes with a cost — the BPaLM regimen costs $570. However, India has been allocated more than 50 per cent of the $500 available with the Global Fund for Malaria, TB, and HIV in its forthcoming 2024-27 grant cycle.
India’s plans would fail unless the price of the drugs are further reduced. MSF has called for the price of a complete DR-TB course, including the BPaLM regimen, to be no more than $500. Price reductions will pave the way for the rollout of this treatment in many more countries.
The theme of World Tuberculosis Day 2023 is “Yes! We can end TB!”. MSF has joined the WHO and other actors in a ‘Call to Action’ to improve access.
This effort would bring in a bigger return as a recent report by the UK parliament suggested that new pandemics would be controlled by putting an end to TB as many programmes, such as prevention, detection, response, and innovation for strengthening pandemic preparedness, overlap with existing tuberculosis programmes.
The report Ready Next Time — beating TB today and preparing for pandemics tomorrow uses real-life examples of excellence from across Africa to illustrate the power of investing in TB to fight future pandemics. For instance, in Nigeria, EPCON AI’s digital surveillance system built for TB was used by partners to identify vulnerable and underserved populations for COVID-19.
Read more: India reports sharp decline in tuberculosis registration after COVID-19 lockdown
Similarly, in South Africa, TASK and SATVI, two clinical research organisations, deployed their expertise from TB to help develop new products for COVID-19.
“No one can afford to spend money on systems that won’t be used until the next pandemic, but they don’t have to. By making the right targeted investments, governments can have an immediate, tangible impact on the fight against TB, and meet international guidelines to prepare for future pandemics. It’s a win-win,” says Janika Hauser, TB researcher and co-author of the report.
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