Shorter and more effective treatment for

people suffering from drug-resistant TB

Dr.Maria Regina Christian

6 April 2023
Presented at Fast Track the Cure webinar
 Estimated number of incident cases of MDR/RR-TB in 2021 for
countries with at least 1000 incident cases

• Indonesia is one of the seven

countries with the highest burden in
terms of numbers MDR/RR TB cases
together with India, Pakistan,
Russian federation, China,
Indonesia, Phillipines and South
Africa
• These countries accounted for two
thirds of global MDR/RR TB cases in
2021

3
4
5
6
 Mar 2019
1. Regimen for Hr TB
2. Composition in longer regime
3. Shorter regimen with SLI (same as 2016
recommendation + role of MTBDRplus rapid
assay and to exclude if there is resistant to both
KatG and InhA mutation.
Dec 2019
1. Shorter, all-oral,
bedaquiline-containing
regimen for eligible MDR/RR-
TB patients
2. Novel treatment regimen –
BPaL under OR
Jun 2020
1. Oral Shorter regimen with BDQ
2. BPaL (6-9 month) under OR
3. Extended BDQ use beyond 6
month , Concurrent use of BDQ and
DLM, use of BDQ during pregnancy
in longer regimen for MDR TB
7
WHO guidance on treatment and management of Drug-resistant TB

2019

15 June 2020
9
Recommendations
The 6-month Bedaquiline, Pretomanid,
linezolid, and moxifloxacin (BPaLM)
regimen for MDR/RR TB (NEW)
WHO suggest the use of a 6-month treatment regimen composed of
Bedaquiline, Pretomanid, Linezolid (600 mg) and Moxifloxacin (BPaLM)
rather than the 9-month or longer (18-month) regimens in MDR/RR-TB
patients

(conditional recommendation, very low certainty of evidence)

10
11
12
Call to Action
Shorter and more effective treatment
for all people suffering from drug-
resistant TB
In 21 March 2023, in conjunction of the commemoration of World’s TB
Day, The World Health Organization (WHO) and its partners are calling
on governments and other stakeholders to accelerate the
implementation of the novel, 6-month all-oral regimen for the
treatment of drug-resistant tuberculosis.
This Call to Action highlights WHO’s latest guidelines on drug –
resistant TB treatment recommend rapid roll-out of the novel
BPalM/BPaL regimen that has the potential to dramatically increase
cure rates due to its high efficacy, allow broader access due to its lower
cost and improve patient quality of life as this regimen is all-oral and
significantly shorter than conventional regimens

13
“WHO, civil society, technical partners assisting
countries, the donor community and others are
joining forces, urging governments to undertake
the following actions with the support of partners
and civil society in 2023-2024”

14
Increase access to rapid and conventional TB diagnostics and drug susceptibility testing in
order to detect TB, rifampicin resistance and resistance to fluoroquinolones, bedaquiline,
pretomanid and linezolid

Update national policies to incorporate new recommendation for use of the all-oral shorter
6-month treatment regimens for drug-resistant TB in a framework of the national
programme that includes antimicrobial stewardship, patient care and support

Initiate and ensure the continuous and affordable supply of the component medicines of the
BPaLM/BPaL regimen and other regiments for the treatment of drug-resistant TB
recommended by WHO

Update national regulatory policies to allow for the importation of new TB medicines and
diagnostics without restrictions and without unnecessary price margins

Seek technical assistance from partners to train national healthcare workers, community
health workers, patient support groups, TB activist, nurses and clinicians to familiarize
themselves with the implementation of the new regimens and to support community
treatment literacy
15
 Seek to learn from the experience of early implementing countries to inform national
policies and to implement new treatments to speed timely access

Allocate sufficient domestic resources and seek funding from overseas donors to allow for full
coverage and care of all people in need of the treatment

Ramp up advocacy efforts to help inform the public decision makers and multiple sectors of
society and ensure the establishment of accountability frameworks to accelerate progress in
the implementation of the novel regimens for TB

Engage in community action to raise awareness and facilitate access to new treatments for all
individuals, including the most vulnerable and disenfranchised parts of the society

Partners with the private sector to ensure wider access to innovation in the diagnosis and
treatment of drug-resistant TB
16
 Coordinate with partners to include digital adherence and monitoring tools with the
implementation of the new regimens

Strengthen national pharmacovigilance system to ensure prompt identification and

management of adverse events

Invest in continued research and innovation to expand available treatment options for TB
infection and disease

17
WHO Response : Leading the call to action
WHO plans to support the rollout of the new 6-month regimen for the treatment of drug-resistant TB
through :
1. Coordinating and facilitating a “BPaLM Accelerator Platform” that gathers all the technical and
funding partners to support the rollout of the regimens in the countries
2. Organizing a series of regional workshops to discuss challenges and practical considerations for the
implementation of the BPaLM regimen at the country level
3. Working with high burden countries to facilitate the introduction of shorter regimens of the
treatment drug-resistant tuberculosis
4. Collaborating with all the technical partners to provide technical assistance to countries on the
implementation of the regimen using the existing technical assistance mechanism, such as regional
Green Light Committees and others
5. Monitoring on an annual basis the uptake of these new regimens and sharing progress on
implementation

18
What is the next step in Indonesia ?
 Adoption of new and existing recommendations along with their safe and timely implementation, in
the context of patient support, will require political commitment with the involvement of national
governments, the private sector, technical partners, civil society and funding agencies

 Yes, BPaLM can and should be applied in Indonesia, but there are several steps to be prepared :
• Scale up implementation plan
• Required system change in all level such as procurement and logistic management, capacity
building and resource mobilization
• Increase demand, awareness and knowledge from clinicians, patients, and community
• Community Engagement
• aDSM
• Monitoring, reporting and recording

19
Thank You
For more information, please contact:
Name : Maria Regina Christian
Title : National Professional Officer Tuberculosis
Email : Christianm@who.int

20