11 April 2018

South Africa: TB Patients Hold Their Breath for Better Treatment

For patients in developing countries, access to two new and improved TB drugs remain scarce.

More than half a million people fell ill with drug-resistant tuberculosis (TB) in 2016, World Health Organisation data shows.

Older treatments for drug-resistant TB can take about two years and patients have to take handfuls of pills daily that put them at risk of conditions such as deafness or psychosis. More than half of patients with the most extreme form of drug-resistant TB - also known as extensively drug-resistant TB - will die, according to University of Cape Town studies.

Two new medicines - bedaquiline and delamanid - can treat drug-resistant TB in six to nine months. But for patients in Kenya, getting access to the drugs is unlikely.

Neither drug has been registered for use in the country, says Allan Maleche, executive director at the Kenya Legal and Ethical Issues Network on HIV and Aids. Kenyan patients can get these medicines with special permission from the government, but very few people qualify. Maleche says about six patients in Kenya have had access to bedaquiline and five to delamanid respectively.

In South Africa, bedaquiline was registered in 2013. It is available at all public sector health facilities, says Anja Reuters, a doctor who specialises in drug-resistant TB for humanitarian organisation Doctors Without Borders. The country is the biggest consumer of the drug worldwide.

Last year, South Africa scored free delamanid from drugmaker Otsuka Pharmaceutical. As part of a pilot project, the company provided enough medicine for 400 patients to complete a six-month course. A course of delamanid cost R21250.

But Reuters says the pilot's strict rules have kept the medicine away from patients. "At first, the pilot excluded children and patients who were also on bedaquiline."

The six-month cut-off per patient also excludes patients for whom very few drugs work, Reuters says.

These patients may need a longer course of delamanid. "Anyone who requires the drug longer than six months won't get access to it."

The protocols have since been relaxed, but to date only 30 South Africans have had access to delamanid.

Meanwhile, the country is still holding its breath for the life-saving drug to be approved for use, Reuters says.

"We're urgently waiting."

Once the drug is registered, MSF hopes delamanid will be more available for groups such as children and adolescents, for whom the medicine is safer than older drugs. Reuters explains: "It's important for children and adolescents to have access to [delamanid] so they don't have to suffer hearing loss."

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