Nearly two years after the World Health Organisation (WHO) recommended a novel oral regimen for drug-resistant tuberculosis (TB) that offers improved, quicker treatment outcomes and enhances patients' quality of life, India is preparing to train healthcare professionals to administer this therapy. Senior officials from the Ministry of Health informed The Indian Express that the training for the new regimen, known as BPalM, will commence by the end of August or early September, starting in Mumbai, Maharashtra, and then expanding to five other locations across various states. According to Dr. Urvashi Singh, Deputy Director General (TB) at the Central TB Division, each of the six training sites will cover around six states.
The BPalM regimen consists of bedaquiline, pretomanid, linezolid, and moxifloxacin (BPaLM) for the treatment of multi-drug-resistant or rifampicin-resistant tuberculosis (MDR/RR-TB). Currently, TB patients in nearly 40 countries have access to this regimen. The BPalM protocol is more effective, reduces the treatment duration from 18-24 months to six months, has fewer side effects, and crucially, helps prevent transmission, making it a vital tool in controlling TB. Given that India accounts for 27% of global TB cases, the country stands to gain significantly from this initiative.
The Health Ministry decided to roll out the BPaLM regimen for drug-resistant tuberculosis based on encouraging findings from an Indian Council of Medical Research (ICMR) studyDr Soumya Swaminathan, Principal Advisor to the Union Ministry of Health and Family Welfare for the National Tuberculosis Elimination Programme
A study coordinated by the ICMR and the National Institute of Research in Tuberculosis, Chennai, has shown over 90 per cent cure rates. Mortality, which is usually 14 to 17 per cent, drops to about three to four percentDr Rajesh Solanki, co-chairman of the national technical expert group of the National TB Elimination Programme
The training will focus on monitoring patients for adverse effects and determining the most appropriate treatment plans. It will be offered to state TB officers, medical officers, and master trainers, who will then pass on their knowledge to others at the district and community levels. This process will help ensure that chest physicians are well-prepared to prescribe the correct drug regimens. Dr. Solanki mentioned that the training sites will likely be in Maharashtra, Uttar Pradesh, Goa, Karnataka, as well as the cities of Kolkata and Chandigarh.
Dr. Singh highlighted the importance of understanding the new treatment during the training sessions. She noted that while the newer regimen may lead to better outcomes, the existing treatments are still effective. Therefore, it is important to exercise caution when transitioning from the previous regimen and to carefully assess where patients who are resistant to TB drugs fall within the treatment spectrum.
This initiative is expected to significantly bolster the National TB Elimination Programme, which aims to eradicate tuberculosis in India by 2025. Dr. Rajesh Solanki, co-chairman of the national technical expert group for the programme, pointed out that a study led by the ICMR and the National Institute of Research in Tuberculosis in Chennai demonstrated cure rates exceeding 90%. Additionally, mortality rates, typically between 14 to 17%, have decreased to about 3 to 4%, underscoring the potential of this drug protocol to revolutionize public health management.
Regarding drug availability, medications like bedaquiline, linezolid, and moxifloxacin are already being procured, while pretomanid is being sourced under the National TB Elimination Programme, with rate contracts in place, as confirmed by Dr. Singh. Dr. Swaminathan also emphasized the importance of expanding the use of molecular tests, such as the nucleic acid amplification test (NAAT). Currently, around 65,000 cases of multi-drug resistant TB are detected annually, making the expansion of NAAT coverage crucial.
(Input from various sources)
(Rehash/Ankur Deka/MSM)