Introduction:
- Introduction of the BPaL regimen (bedaquiline, pretomanid, linezolid), with potential to revolutionize treatment:
- Duration reduced to six months.
- All-oral treatment with fewer pills and reduced toxicity.
- Clinical trials (Nix-TB and ZeNix) have demonstrated efficacy and better tolerance with adjusted linezolid dosage.
Relevance : GS 2(Health )
Challenges in Current TB Treatments:
- Drug-resistant TB (MDR-TB):Resistance to rifampicin and isoniazid poses high mortality risks (30-40%).Prolonged regimens (18+ months) with significant side effects led to poor adherence.
- Toxic side effects from previous treatments:Pain, hearing loss, depression, and social stigma exacerbated patient suffering.
- Systematic neglect of patient demands for shorter, less toxic treatments.
Advantages of the BPaL Regimen
- Reduced Treatment Duration: Improves adherence and decreases economic burden.
- Low Pill Burden: Encourages better patient compliance.
- Enhanced Tolerance: Lower toxicity compared to previous regimens.
Caveats to Consider
Adherence Monitoring:
- Resistance to bedaquiline has been reported in patients failing treatment.
- Phone-based and digital adherence tools must be integrated.
Drug-Susceptibility Testing (DST):
- Essential for ensuring regimen suitability.
- Early universal molecular diagnostics are necessary to detect resistant strains.
Adverse Effects:
- Linezolid-associated sensory neuropathy requires vigilance.
- Alternative regimens must be defined for intolerant patients.
Health System Preparedness
Training of Physicians:
- Comprehensive training for management of MDR-TB cases and side effects.
Public-Private Partnerships (PPP):
- Crucial for ensuring universal access, particularly for patients accessing private healthcare.
Cost Implications:
- Shorter regimens are expensive but offer long-term benefits by reducing patient suffering and improving outcomes.
Structural Barriers in TB Management
Stigma and Economic Burden:
- TB patients face societal and workplace discrimination.
- Nutritional and economic support is vital to address inequalities.
Social Determinants of Health:
- TB prevalence is influenced by poverty, overcrowding, and poor nutrition.
- Addressing root causes is critical to long-term eradication efforts.
Way Forward
Person-Centred Care:
- Focus on engagement, counselling, and support for patients and their families.
Community Education:
- Awareness programs to improve treatment adherence and reduce stigma.
Systemic Transformation:
- Beyond new regimens, a holistic approach addressing socio-economic determinants is essential.
