India’s TB problem and the right to treatment

Several Indian companies make such molecular tests. India has also invested heavily in molecular platforms during Covid-19, and these must be repurposed to fight TB. During Covid-19, many Indian companies also manufactured lower-cost reagents and supplies to make PCR more affordable.

Shortening the duration of DR-TB treatment from 24 months to 6 months is a big improvement. We can now treat the more serious form of the disease with just oral medications and avoid painful injections.

In December 2022, WHO recommended the use of the BPaLM/BPaL regimen for DR-TB patients, which offers a s much higher success rate of 89 per cent, reduces the pill burden to only three to four pills a day and shortens the treatment duration. Studies estimate an annual saving of $740 million globally because of transition to BPaLM/BPaL. With India accounting for a third of the global MDR/RR-TB treated patients this could mean a saving of nearly $250 million per year for the country.

However, India continues to use a mix of treatment options, most of which are difficult to adhere to. As per the India TB Report 2023, over 22,000 Indian MDR/RR-TB patients in 2021 were on treatment regimens which contained injectables — the WHO has recommended phasing out injectables in 2019. Only 68 per cent of the MDR/RR-TB patients initiated on treatment in 2020 successfully completed treatment. Moreover, in 2022, only 53 per cent MDR/RR-TB patients (~31,000) were put on the shorter bedaquiline-containing regimen, the preferred drug for DR-TB, recommended by the WHO since 2019.

Most notably, India is the only global supplier of pretomanid, a key drug within the BPaL regimen. However, only 403 patients in India have so far been administered the pretomanid-containing BPaL regimen through a clinical trial.

As a physician, researcher and a TB cure advocate, I firmly believe that every individual has the right to access diagnostic and treatment options that offer them the best chances of recovery. Thankfully, we now have highly accurate tools to detect DR-TB, and we can cure DR-TB within six-months with oral medications. In 2023, these new tools must be easily and widely available to all people with DR-TB in India. No one should suffer or die from drug-resistant TB.

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The writer is a medical doctor, and the Canada Research Chair of Epidemiology and Global Health at McGill University, Canada.