DR-TB drugs under the microscope: five urgent actions to improve DR-TB treatment (6th edition)

This new MSF report provides an overview of the landscape of optimal treatment for drug-resistant TB (DR-TB), outlines the key barriers to accessing affordable effective treatment, and provides recommendations for action that can improve DR-TB care on a global scale.

There is much in need of improvement. According to WHO Global TB Report 2019, in 2018: Of the estimated half a million people fell ill with MDR/RR-TB, only 39% of people with MDR/RRTB were diagnosed, and only 1 in 3 people with MDR/RRTB were started on treatment. According to the latest global cohort data available, cure rates are still unacceptably low:: 56% and 39% of people treated for MDR/RR-TB and XDR-TB, respectively.

Countries to make a timely switch to the newly recommended all-oral drug regimens, discontinuing the use of harmful and difficult-to-use injectable agents, and prioritising the use of the newer drug bedaquiline.

Johnson and Johnson (J&J) to reduce the price of bedaquiline to no more than US$1 a day, especially given the fact that substantial public and philanthropic funding went into the development of bedaquiline. This public collective effort in drug R&D for bedaquiline needs to be reflected in its availability for people with DR-TB for whom access to this medicine is a matter of life or death. Since bedaquiline was recommended in WHO’s August 2018 rapid guidance as a core drug to treat MDR-TB, less than 12,000 have received bedaquiline-containing regimens (according to DRTB STAT).

Countries to overcome restrictive patents and exclusive licensing of key TB drugs, including bedaquiline and delamanid, in order to facilitate generic competition to bring down prices and increase access.

Countries to adopt effective national drug procurement policies in order to reduce risk to quality, affordability, access to critical TB medicines, particularly as more country shift from the Global Fund -supported pooled procurement mechanisms to domestic national processes.

Governments to support public health-drive R&D and better governance of new medical tools to ensure affordable and sustainable access.