endTB: Introduction of new TB drugs for the treatment of multidrug-resistant tuberculosis (MDR-TB)

Challenge

MDR-TB is caused by tuberculosis (TB) strains that are resistant to first-choice of treatment. In 2015, WHO estimated at least 250,000 deaths caused by MDR-TB globally. The standard treatment for MDR-TB is a grueling two-year treatment where patients need to take as a many as 20 pills a day, endure painful injections, many of which cause debilitating side effects, including permanent hearing impairment.

Most MDR-TB patients who manage to access MDR-TB treatment are treated with drugs of unknown quality. Incorrect or inadequate treatment with second-line TB drugs can lead to amplification of resistance and creation of extensively drug-resistant (XDR) or even total drug-resistant (TDR) strains.

However, this has changed! Bedaquiline and delamanid are the first drugs developed for TB in almost 50 years. Both drugs have been recommended by the World Health Organization (WHO) for use in patients with resistance to either the injectable or fluoroquinolone classes. While countries differ widely, at least one-third of the MDR-TB patients globally need new TB drugs. Therefore, there is an urgent and unmet need to expand access and advocate the use of these new drugs in all high TB and MDR-TB burden TB countries.

Our Approach

IRD is a consortium partner for the endTB (Expand New Drug markets for TB) Project, a multi-country effort to introduce Bedaquiline and Delamanid free-of-cost to MDR-TB patients in 17 countries across four continents.

IRD is implementing this project at specific treatment sites in five countries – Bangladesh, Indonesia, Pakistan, South Africa and Vietnam. The endTB project will build evidence of the efficacy and safety of new TB drugs in order to influence and generate market demand – and thereby help widen the availability and access of these drugs to all affected populations.

This four-year project is funded by UNITAID, and is being implemented by Partners in Health (PIH) and Médecins Sans Frontières (MSF) in other countries.

Impact

IRD has successfully enrolled over 450 MDR-TB patients, and aims to enroll thousands more eligible patients in coming years, both through the endTB project as well as through transition and scale up by national programs in implementing countries.