Taking TB seriously: On the BPaLM treatment regimen for drug-resistant tuberculosis
Early adoption of the new treatment regimen is welcome
Time is of the essence in adopting advanced technology in medical care. When medical technology arrives dragging its feet, then its transformative effects are not that dramatic. The Union Health Ministry’s decision to introduce the new treatment regimen for drug-resistant tuberculosis hardly a couple of years after it was recommended by the World Health Organization (WHO), is a step in the right direction. Last week, the government approved the BPaLM regimen comprising four drugs — Bedaquiline, Pretomanid, Linezolid and Moxifloxacin. This regimen has been proven to offer better outcomes, remarkably shortening the duration of treatment, and resulting in improvements in quality of life for persons living with multidrug-resistant tuberculosis (MDR-TB), which resists treatment by isoniazid and rifampicin, the two hitherto frontline drugs in TB treatment. The move makes tremendous sense for a country that voluntarily set itself an earlier target for TB elimination by 2025, five years ahead of the global target under the UN Sustainable Development Goals. TB elimination means there should be under one case of TB for a population of 10 lakh. Traditional treatments can last up to 20 months, and entail severe side effects for the patient. The BPaLM regimen is reputed to cure drug-resistant TB in just six months, with a high success rate. It is particularly significant in this country, because an estimated 75,000 people living with drug-resistant TB can now switch to this shorter, cheaper treatment regimen. This move, experts endorse, will undoubtedly improve treatment outcomes and help thousands of patients.
The government has, admirably, shown a commitment and political will to see the back of TB, and has, over the years, implemented several measures in aid of this. Shifting from conventional culture and drug sensitivity testing to rapid molecular tests for diagnosing MDR-TB has resulted in improved case detection, higher treatment coverage, better treatment success rates, and falling death rates. Extra support (financially, nutritionally and societally) in the form of the Ni-kshay Mitra scheme has also yielded results. India’s reduction of TB incidence by 16% from 2015 to 2022 is almost double the pace at which global TB incidence is declining, as per WHO’s Global TB Report 2023. Mortality has also reduced by 18% during the same period in India. It was India which led the way earlier with its Directly Observed Therapy Short-course programme, revolutionising TB care back in the day with supervised administration of drugs. Centring its patients, the government should not merely follow, but be a pioneer in diagnosing and treating TB.