Africa: MSF Urges Scale Up of TB Testing and Rollout of Safer, Shorter Drug-Resistant TB Treatment

Médecins Sans Frontières (MSF) calls on governments and donors to speed up access to new, shorter, safer and more effective treatments for drug-resistant tuberculosis (DR-TB). MSF joined the World Health Organization (WHO) and other organisations in a ‘Call to Action’ ahead of World TB Day.

MSF also urges the US-based diagnostics corporation Cepheid to drop the price of the critical GeneXpert tests, and for governments to scale up access to diagnostic test, to ensure that people with DR-TB can be diagnosed in time to access the shorter and safer treatment regimens.

If only I had started the [new] treatment with a short course right away, my life would have been different. Maria, a patient who underwent two years of treatment, and later received the new regimen

WHO issued new guidelines in December 2022 that recommend countries roll out the safer and shorter regimen, BPaLM*, to treat people with DR-TB, partly based on the results of MSF’s TB PRACTECAL trial. The trial is a multi-country, randomized, controlled clinical trial showing that the new, all-oral six-month BPaLM based treatment is safer and more effective at treating DR-TB than the currently used treatment regimens. Current regimens are longer, cause intolerable side effects, and only cure 60 per cent of people with DR-TB.

“For me, everything over the past two years has revolved around TB,” says Maria**, who underwent two long years of treatment which failed to cure her of DR-TB. She later received the BPaLM regimen in Belarus. “Living like that was impossible. People [on the old treatment] can’t do anything because they feel awful during the treatment. If only I had started [the new] treatment with a short course right away, my life would have been different.”

Access to diagnostic testing for drug resistance to the TB bacteria is one of the main hurdles to rolling out the safer and shorter DR-TB treatment regimens. The GeneXpert MTB/RIF test made by US corporation Cepheid is currently the most widely available rapid molecular diagnostic test in high TB burden countries to detect resistance to first-line drug rifampicin.

Despite high sales volumes in high TB burden countries, and MSF’s analysis showing that it costs Cepheid less than US$5 to produce one test, Cepheid has kept the price of the test at US$9.98 for over a decade.

Countries should start rolling out the six-month BPaLM regimen to treat DR-TB. They should also ensure nation-wide availability of the GeneXpert MTB/RIF tests or, where possible, WHO-recommended alternatives such as the Truenat MTB/RIF tests. This is to ensure scaled up detection of TB and rifampicin resistance so that people with DR-TB can receive the shorter treatment without any delay.

“It is critical that we have better access to tests to diagnose TB and detect resistance to drugs used for treating TB so that we can identify more people who need treatment and rollout the shorter and safer all-oral treatment regimens,” says Stijn Deborggraeve, Diagnostics Advisor at MSF’s Access Campaign. “We call on Cepheid again to reduce the price of the TB tests to no more than US$5 each, so that more people with DR-TB can be diagnosed in time and be offered improved, lifesaving treatments.”

Prices of the drugs used in shorter regimens also need to come down further. What will help is national TB treatment programmes rolling out these regimens to more people in order to increase demand, as well as having more manufacturers supplying affordable generic versions of bedaquiline and pretomanid, two of the drugs in the BPaLM regimen.

The lowest-available price for this newer DR-TB treatment regimen is still US$570, and MSF has called for the price of a complete DR-TB course, including the BPaLM regimen, to be no more than US$500.

Governments, donors and pharmaceutical corporations must act now to ensure an affordable supply of these critical tests and treatments for TB, so that more lives can be saved. Dr Geke Huisman, MSF medical coordinator in Afghanistan

Five countries where MSF works have started implementing the shorter regimens: Belarus, Uzbekistan, Tajikistan, Sierra Leone and Pakistan. Further price reductions will pave the way for the rollout of this treatment in many more countries.

“In a country like Afghanistan, where people are struggling to afford basic food items, travel expenses and medical fees, being able to treat people with drug-resistant TB within six months would be a blessing,” says Dr Geke Huisman, MSF Medical Coordinator in Afghanistan. “Access to affordable diagnostic tests remains a major challenge in Afghanistan and other countries in this region because of the high prices of tests.”

“Governments, donors and pharmaceutical corporations must act now to ensure an affordable supply of these critical tests and treatments for TB, so that more lives can be saved,” says Dr Huisman.

*The six-month BPaLM regimen is composed of bedaquiline (B), pretomanid (Pa), linezolid (L) and moxifloxacin (M). This regimen will not be appropriate for people with TB resistant to bedaquiline, linezolid, pretomanid or delamanid. In parallel with implementing the BPaLM regimen, all countries should urgently scale up access to drug susceptibility testing for the drugs used to treat DR-TB.

** Full name not being shared to maintain anonymity