Treatment & Care
Treatment options for people with multidrug-resistant or rifampicin-resistant tuberculosis (MDR-/RR-TB) have been improved and brought new hope. Read more below on the latest developments.
The focus on Treatment and Care lives on improving people-centred treatment of active TB, including drug-resistant TB. We support widening access to innovative, shorter, all-oral TB treatment regimens through their effective implementation, particularly in countries with high incidence of TB. To this end, we aim to ensure that comprehensive implementation toolkits for these regimens are available and used in all countries.
We believe that TB can only be effectively addressed if people have access to TB testing, prevention and care close to their homes with support tailored to their needs. The team is therefore working towards the effective decentralization of TB care, from hospitals to primary care facilities and in communities. We support the implementation of easy-to-use diagnostics (particularly at the point of care) and effective treatment monitoring (for example, using blood or urine to replace culture-based approaches for follow up).
Recognizing the role that co-morbidities play in the health impact of TB, we support the integration of diagnosis of TB and co-morbidities, and the management of TB-related health problems, such as anti-smoking support, malnutrition, diabetes and mental health conditions. Learn more about TB+ here.
Improved treatment options
Significant improvements have been made in treatment options for people with multidrug-resistant or rifampicin-resistant tuberculosis (MDR-/RR-TB). The most recent WHO Guidelines on the treatment of MDR-/RR-TB, released in December 2022, recommended the use of a shorter (6-months), all-oral, effective, treatment regimen containing bedaquiline (Bdq), pretomanid (Pa), linezolid (Lzd) with/or without a fluoroquinolone (moxifloxacin; Mfx) – the so-called “BPaLM/BPaL regimens” under the programmatic conditions as the regimen of choice for eligible patients over the previous 9 – 18 months treatment regimens. These novel regimens have a positive impact on patient adherence, improve treatment completion and treatment success rates as they are shorter, effective with less pill burden, and more tolerable to patients. They have also been shown to be cost-effective. Widespread introduction of these regimens, with patient-centered care, is urgently needed, both by National TB Programmes (NTPs) and by patients.
After successful implementation of the BPaL Operational Research (OR) activities under the LIFT-TB project (Indonesia, Kyrgyzstan, Myanmar, Philippines, Ukraine, Uzbekistan, and Ukraine), TB REACH Wave 7 projects (in Tajikistan and Ukraine), and a direct KNCV-funded project in Nigeria, currently KNCV is technically supporting countries to implement the recently recommended BPaL-based treatment regimens for programmatic use. This includes assistance to develop programmatic implementation plans, updated national guidelines, job aids, training materials, and assisting in ensuring an active drug safety and monitoring system, recording and reporting system, and monitoring and evaluation, are in place.
Easily incorporated
Available generic tools such as the BPaL OR protocol, clinical guide, and related materials, have been updated to be easily incorporated into the national TB guidelines. This can guide countries improve their policies for programmatic implementation of the BPaL(M). Capacity building will provide NTPs with the required skills to implement the regimens. Understanding the importance of patient-centered care, the KNCV programmatic implementation package includes innovations that simplify treatment adherence and safety monitoring, such as digital adherence tools and the use of a portable smart device for ECG monitoring.
