"An ongoing ICMR study is evaluating the BPaL regimen in many centres across the country, including my hospital. Preliminary results are expected to be shared in 2024 and by 2025 we will have the final results to be able to roll out this regimen", informed Dr Surya Kant, Head of the Respiratory Medicine Department at King George's Medical University (KGMU).
Meanwhile, India is already using bedaquiline and delamanid based 9-11 months long, all oral regimens to treat drug-resistant TB. The uptake of this shorter treatment regimen is fairly good and it is well entrenched in the National TB Elimination Programme, said Dr Sachdeva.
However, he cautioned against doing away completely with the longer duration treatment. "MDR-TB is complex to treat and we have close to 10-15 drugs for it. We have to ensure that the patient is sensitive to all the drugs that he/she is given. If there is a varying sensitivity pattern and they are sensitive to a lesser number of drugs, then we have to design a regimen that best suits their clinical profile. So some MDR-TB patients may still need to be put on the longer all oral regimen, even after the short regimen is introduced. We should not do away with the longer regimen. Also, even if there is a very small number of patients who need injectables and are not tolerating the oral replacement therapy, we should not totally junk the injectable drugs and they should be kept in reserve. We do not want any patient to suffer any chronic morbidity or mortality just because there is no option to treat them with other drugs", opined Dr Sachdeva.
Menghaney laments that while we are on the cusp of breakthrough for adults with short oral regimens, children with TB have been neglected and are at the bottom of hierarchy. While we have child friendly formulations of linezolid based regimens, we do not have generic versions of paediatric formulations containing Delamanid. We have to replicate adult regimens for children faster. We cannot leave them behind.
Menghaney's concerns are real and corroborated by the poor progress made in achieving the target set at the "UN high-level meeting on TB" of putting 115000 children globally on MDR-TB treatment during 2018-22. Only 15% of this target was met by 2021.
Match optimism with actions on the ground
India remains one of the top 30 high TB burden countries and one of the 10 countries that have a high burden of all three: TB, HIV-associated TB and MDR-TB and rifampicin-resistant TB. The rate at which new infections of TB are declining in India every year is low. But the Indian government has promised to end TB by 2025 - five years ahead of the global target to eliminate it by 2030.
"India has set ambitious targets. Now, we need to match this optimism with our actions on the ground, so that these targets are reachable. Shorter regimens will help not just India but all countries in ending TB and delivering on SDGs also because we will be spending resources wisely as this regimen makes economic sense for the patient and service providers - which means we can treat and serve more patients - or use those resources to improve diagnostic coverage", says Sinha.
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