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The World Health Organisation has just recommended that countries move toward shorter treatment regimens for some people with drug-resistant tuberculosis (DR-TB), including people co-infected with HIV, children, and people with simple MDR-TB who have not been treated before or and have no known resistance to any of the drugs in the regimen.
This recommendation comes following results from a number of large observation cohort studies using the shortened regimen.
Current DR-TB treatments usually run for 24 months and cause significant side effects; shortened regimens, which run as few as nine months, lessen disruption of patients’ lives and are easier for patients to tolerate and adhere to.
WHO is also recommending that people with confirmed rifampicin-resistant TB or multidrug-resistant TB (MDR-TB) be tested for extensively-drug-resistant (XDR) and pre-XDR-TB using rapid molecular tests as the initial test, so that they can be offered treatment that is appropriate for them as soon as possible.
MSF responds to the new WHO recommendations with the following two statements:
David Lister, TB doctor for MSF in Uzbekistan and coordinator of the Nine-Month Short Course Regimen study: “The prospect of two years of TB treatment drives parents to hide their children from treatment, teenagers to abandon their ambitions, adults to decide between providing for their family or getting healthy and the elderly to wish for death.
“The fear of relentless suffering due to side effects manages to outweigh any hope of cure or returning to a normal life. But when I tell patients that it’s only nine months of treatment, they respond, ‘I can do that.’”
Dr Philipp du Cros, Head of MSF’s Manson Unit and infectious disease specialist: “WHO’s recommendation to move toward shorter treatment regimens for some people with DR-TB is a positive step and countries should waste no time in putting these recommendations into practice, where feasible and appropriate.
“Although this treatment isn’t suitable for all patients, MSF has seen positive outcomes using a nine-month regimen in Swaziland and Uzbekistan. Shorter regimens are easier for people to tolerate and more effective for some people with DR-TB, and significantly lower costs could enable TB programmes to scale up treatment for many more people.
“Ultimately, we can’t lose sight of the desperate need for completely new treatment regimens that work for all people with drug-resistant TB and that completely eliminate the old, toxic drugs still used in these shorter regimens, particularly the daily painful injections that people must endure.
“We also welcome WHO’s recommendation that people should be diagnosed for pre-XDR or XDR-TB using the latest rapid molecular tests that can detect resistance to key second-line drugs; this is essential to ensure people who can benefit from a shorter treatment regimen can be quickly identified and started on the treatment that’s right for them.
“The newly-recommended tests are only suitable for use in central or regional-level laboratories, so in the long run, in order to get the most number of people diagnosed and on the correct treatment, we need rapid molecular diagnostic tests that can detect drug resistance and can be used in more peripheral settings.
“These recommendations come ahead of expected new guidelines from WHO for the management of MDR-TB, but countries can already start to update their national treatment guidelines so people can benefit from the latest advances in MDR-TB care.”
— MSF Field (@msf_field) May 9, 2016
Twenty-seven-year-old Sikhumbuzo Thwala is a male patient living in the remote area of Mankayane in Swaziland.
"I was diagnosed with a HIV and DR-TB co-infection in October 2015. I had been very sickly and eventually decided to go to the Mankayane Hospital in October 2015, where I was tested and diagnosed with a HIV / DR-TB co-infection.
Before I started treatment the doctor explained that there were two options of treatment-I had a choice between treatment that would take more or less two years with about eight months of daily injections, or a shorter treatment option of nine to twelve months including daily injections for about four to six months. I chose the nine-twelve months TB treatment after being taught on both types of treatment (the 18-24 months and 9-12months).
Before I started my MDR-TB treatment I was working as a seasonal maize farmer and the breadwinner for my family. I come from big family with ten children including my brothers, sister and my nephews. I also have a wife and two children of my own. All of them depend on me for their welfare. I also enjoyed playing soccer and was part of a local soccer team.
When I was very sick my life came to a standstill. I had to give up work and was too weak to play football.
I am so glad that I chose to be treated using the shorter nine months treatment. My recovery has been so effective and fast. I finished the injection phase of my treatment on 03 March 2016.
I am happy to be back at work. I am now working full time in the fields without any challenges. I have also gone back to playing soccer. Now I play the full duration of a soccer match. Before, when I was still taking my injections, playing was a strain. I would play for about fifteen minutes because I suffered from numbness as a side effect of the injections.
I would not have gotten this far with my treatment without the support of my wife who is also my treatment supporter. The MSF mobile team has also been very supportive- visiting me regularly to check that I’m taking my treatment well, and ensuring that I am practicing proper infection control measures. The on-going follow up and counselling goes a long way.
I am determined to complete my treatment without any complications. That is why I have always taken my treatment serious. I continue to take my medication as instructed by the doctor so that I can soon join my family in the main house. For now I have a back room at home where I sleep as an infection control measure."
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