Shorter regimen for drug resistant TB

BEING diagnosed with tuberculosis (TB) sounds like a death sentence to some due to the long period of treatment, which is between 18 and 24 months. The process becomes even more rigorous for those suffering from multi-drug resistant tuberculosis (MDR-TB). This has seen some TB patients developing treatment fatigue, hence opting out of the treatment process.

This move puts them at risk of developing Extensive Drug Resistant (XDR) TB. However, there is a ray of hope for the MDR-TB patients as the World Health Organisation (WHO) recently availed a shorter treatment regimen for the disease.

WHO also availed a rapid diagnostic test that will improve treatment and speed up detection. At a cost of less than US$1 000 per patient, the new treatment regimen can now be completed in nine and 12 months.

While first-line therapy drugs cost US$31 for the whole course per patient, the resistant TB requires more than US$2 500. The diagnostic test – MTBDRsl – is DNA based and identifies genetic mutations in MDR-TB strains that makes them resistant to second-line TB drugs (fluoroquinolones and injectables).

This test yields results in just 24 to 48 hours, down from the three months or longer that is currently required. The much faster turnaround time means that MDR-TB patients with additional resistance are diagnosed more quickly and placed on appropriate second-line regimens.

With this development, health experts anticipate improved outcomes due to better adherence to treatment. WHO Global TB Programme director Dr Mario Raviglione applauded the development.

“This is a critical step forward in tackling the MDR-TB public health crisis,” he said. “The new WHO recommendations offer hope to hundreds of thousands of MDR-TB patients who can now benefit from a test that quickly identifies eligibility for the shorter regimen and then complete treatment in half the time, at nearly half the cost,” he said.

WHO reports that fewer than 20 percent of the estimated 480 000 MDR-TB patients globally are currently being treated properly.

Health and Child Care ministry’s director for Aids and TB Unit Dr Owen Mugurungi said Government will adopt the new guidelines accordingly.

“We will look at the new guidelines and try to adopt them but it won’t be a quick transition from the current existing regimens we have,” said Dr Mugurungi.

“The only challenge is we buy medicines in advance and even if we adopt the new guidelines today, we still have to exhaust what we have in stock,” he explained.

The shorter regimen is recommended for patients diagnosed with uncomplicated MDR-TB, those not resistant to second-line drugs as well as those who have not yet been treated with second-line drugs.

WHO estimates that Zimbabwe had 820 MDR cases among all TB cases recorded in 2014 basing on the 1994 survey which revealed that 1,9 percent of all new TB cases and 8, 3 percent of previously treated cases were MDR.

MDR-TB is caused by a bacterium (mycobacterium tuberculosis) that has developed a genetic mutation(s) such that a particular drug or drugs is no longer effective against the bacteria.

Health experts concluded that MDR-TB is resistant to at least isoniazid and rifampicin, the two most potent anti-TB drugs.

MDR-TB is one of the greatest health threats that the country is facing, worsened by poor nutrition.

Health experts say poor nutrition is common amongst people with active TB. The disease may lead to underweight and micronutrient defiencies by increasing energy requirements, poor metabolism and loss of appetite.

To that effect, Global Fund donates a monthly US$25 allowance to MDR-TB patients so that they can supplement their diets.

In Sub-Saharan Africa, MDR-TB cases have risen 10-fold in a decade as HIV has spread through the community, and this increase imposes a strain on the health system and the region’s ability to manage TB effectively.

South Africa, Democratic Republic of Congo, Nigeria and Ethiopia are part of the 27 high MDR-TB burden countries of the world. Zimbabwe is one of the countries heavily burdened by TB.

According to the 2013 national estimates, a total of 2 300 people succumbed to TB in Zimbabwe while 5 200 deaths were recorded for people with HIV-TB co-infection.

The country’s 2015-2017 National Strategic Plan hopes to increase treatment success rate of drug resistant TB from 59 percent in 2011 to 75 percent in 2017 and also reduce the incidence of all forms of TB by 80 percent from 562 per 100 000 in 2012 to 112 per 100 000 in 2025.

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