LIVERPOOL, England – In Lesotho rough terrain and long distances between tuberuculosis patients and health providers challenged rollout of the newest medicines that for many have come to represent both optimal care, and a last resort. In eastern European Georgia, high rates of hepatitis C, and still limited knowledge of drug interactions between the newest anti-TB medicine and its effects on the liver are the issue. In Peru, monitoring to ensure the correct use of the new medicine was challenged by gaps in engagement between the health ministry and community. And in Armenia, the challenge of monitoring more than one dose a day was met with treatment directly observed by video.
All four efforts prevailed, getting medicine to patients under far less than optimal conditions, preliminary results revealed this week from the ENDTB Initiative to make bedaquiline and delamanid — the newest, and for many, last resort drugs to treat tuberculosis — available to 750 patients across four countries. Patients reached included incarcerated people and people living with HIV. The difficulties encountered in each of the first four were diverse, but the reasons for overcoming them were shared, including the devastating side effects of the currently widely available drugs to treat tuberculosis, that include psychosis and permanent deafness, Dr. Carole Mitnick of Partners in Health noted at a presentation of preliminary results of the initiative from the first four countries Thursday.
The results so far, she said, show that programmatic use of bedaquiline and delamanid is possible in a range of settings, including prisons, and ones with high rates of HIV and hepatitis, that decentralizing use of the drugs for administration in remote settings, is possible and that local engagement will be critical to future success.
The End TB Initiative, a collaboration of national health ministries with contributions from Partners in Health,Médecins Sans Frontières, Interactive Research and Development, and UNITAID, aims to provide bedaquiline and delamanid access to 2600 patients across 15 countries within the next four years.