The ManicaPost
Catherine Murombedzi: Health Correspondent
We can breathe a sigh of relief as multi-drug resistant tuberculosis (MDR-TB) which took two years to be treated can now be taken care of in half the time. There has been a breakthrough as a study that was undertaken demonstrates far shorter, more effective treatment for multi-drug-resistant tuberculosis (MDR-TB), with majority cured.These findings were announced at the 47th Union World Conference on Lung Health in Liverpool, UK last month. The results demonstrated nine-month treatment had 82% success rate, compared with previous standard that required more than 20 months of treatment and achieved cure rates of 55% and below.;
The study taken in 9 Francophone countries in Africa was taken in Burkina Faso, Benin, Burundi, Cameroon, Central African Republic, Cote d’Ivoire, DRC, Niger and Rwanda. A total of 1 006 patients who were resistant to rifampicin (RR-TB) showed limited adverse reactions in the nine month treatment regimen.
“The Francophone study is a breakthrough in the fight against drug-resistant TB,” said Dr Paula I Fujiwara, Scientific Director of the International Union Against Tuberculosis and Lung Disease (The Union).
“These results have now been replicated in many different settings and with a large number of patients, showing conclusively that this is the most effective treatment for drug-resistant TB discovered to date,” he added.
The previous standard regimen for treating drug-resistant TB lasted 20 months or more and achieved cure rates below 55 percent. Based on the Francophone’s strong preliminary data presented in December 2015, the World Health Organisation (WHO) in May 2016 recommended that the nine-month treatment regimen be used in place of the previous regimens.
“With strong evidence now showing that this regimen is the most effective available for treating multi-drug-resistant forms of TB, the next step is for countries to begin widely implementing this new approach,” said Dr Arnaud Trébucq, a Senior Consultant with The Union.
Among the 1 006 patients who participated in the study, treatment was successful for 821 (82 percent), of whom 734 were cured.
These were defined as patients who completed the full course of treatment without evidence of failure.
The patients produced samples that tested negative for the presence of TB bacteria three times before treatment completion, using a culture test. A culture test, in which colonies of TB bacteria are cultured within a growth medium, is the most rigorous test available for identifying the presence of TB.
An additional 87 patients successfully completed the full course of treatment without demonstrating any signs of treatment failure but had less than three negative culture results. An additional 54 patients (5 percent) did not respond to the treatment, 82 patients (8 percent) died, and 49 (5 percent) were lost to follow-up. The death rate was higher among patients with HIV-infection, but among patients who survived, the regimen demonstrated similar success rates in HIV-infected and non HIV-infected patients.
The study was carried out by researchers from The Union, together with the Institute of Tropical Medicine of Anvers (Belgium), the San Raffaele Scientific Institute of Milan (Italy) and the teams of each of the nine participating countries which included clinicians, National Reference Laboratories and National Tuberculosis control Programmes.
In September 2016, the United Nations General Assembly issued a declaration committing to take worldwide action against drug-resistant TB. The declaration recognised that within the broader context of antimicrobial resistance, resistance to antibiotics “is the greatest and most urgent global risk, requiring increased attention and coherence at the international, national and regional levels.”
Zimbabwe has a growing challenge of multi-drug resistant TB too and these patients showed failure to successful treatment with rifampicin and isoniazid can now take a sigh of relief.
For most local patients not completing treatment distances they have to travel to the health care centres is the main challenge. Tablet fatigue also sets in as the procedure took too long. For one to be cured, the duration can’t see one hospitalised for that long, it becomes a challenge. For a patient to travel to the health care centre everyday for the injection for the first six months too becomes a challenge and this shorter regimen is surely a welcome relief.
In an interview over the chat Dr Owen Mugurungi, the National Director in the AIDS and TB Unit in the Ministry of Health and Child Care said the country would go through an adaptation process and make sure existing stocks were utilised.
“Yes we want to move in that direction we have to go through an adaptation process where considerations will be made. How to utilise and make sure the existing MDR drug stocks are not wasted or do not expire. The cost and availability of resources to procure the new drugs will be taken into consideration,” said Dr Mugurungi.
This move will bring adherence in multi-drug resistance tuberculosis management in most patients.
Dr Mugurungi went on to say that the ministry realizes the advantages of using the shorter course regimen.
“Ministry sees the advantages of the shorter course and would really want to move in that direction,” said Dr Mugurungi.
He went on to say less pill burden would reduce defaulting.
“The short course treatment has less pill burden, better compliance and adherence with treatment. It has lower incidence of side effects,” he added.
He said it would also save on storage space.
“New regimen needs less space for storage, less transport costs and better logistics,” said Dr Mugurungi.
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