Fighting drug-resistant TB: What India can learn from S Africa's success

If India follows new World Health Organization (WHO) guidelines released in August 2018 and reiterated on December 21, 2018, other drug-resistant TB patients will not have to struggle similarly.

In July 2017, 40-year-old Noludwe Mabandlela, a single mother of two, collapsed at home. This ended up saving her life. The ambulance that responded took Mabandlela to the nearest government community health centre, where she was diagnosed with multi-drug resistant tuberculosis (MDR-TB). As the name suggests, first-line drugs such as rifampicin used to treat the more common, drug-sensitive TB don’t work on MDR-TB, from which patients have an increased risk of death and from which they take two years to recover, compared to six months in conventional TB.

Forty-year-old Noludwe Mabandlela, a single mother of two, received new TB drugs bedaquiline and delamanid for multi drug-resistant TB and, a year later, now hopes to make a full recovery. Here, she shows a photo of herself before she contracted MDR-TB.

Until then, an ailing Mabandlela--who lives in Khayelitsha, South Africa’s largest township, or informal settlement, 30 km southeast of Cape Town--had been going to a private hospital, where she was not tested for TB. Government health staff started Mabandlela on MDR-TB treatment, which included taking injectable drugs for six months. She developed side-effects from the drugs, including numbness in her feet, hearing loss and kidney impairment.

Mabandlela was then put on bedaquiline--the first new TB drug developed in nearly 40 years--through the South African department of health’s National TB Control Programme (NTCP). Since 2015, South Africa had started making the drug available in the NTCP for patients with extensively drug-resistant TB (XDR-TB)--the most severe form of MDR-TB--and for patients like Mabandlela who developed severe side-effects from MDR-TB drugs.

Mabandlela also received another new TB drug delamanid from international humanitarian aid organisation Medicins Sans Frontieres (MSF), in November 2017. These new drugs are still not commonly accessible--just over 24,000 of the world’s 558,000 MDR-TB patients have received bedaquiline till August 2018, and only 2,020 have received delamanid.

Mabandlela, HIV-positive and a cancer survivor, had almost given up hope as she lay hospitalised for a month. Now, over a year since her treatment began, she hopes to make a full recovery. Her story is a beacon of hope for MDR-TB patients globally.

Till 2014, almost one in two MDR-TB patients in South Africa were not successfully treated, according to a retrospective study of 19,000 patients published in The Lancet Respiratory Medicine journal in July 2018. Two out of 10 MDR-TB patients in the country died during the 18- to 24-month long treatment, the study found.

Business Standard