SA’s visionary research leads to new WHO guidelines for improved TB treatment

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Ndjeka explained that the new WHO guidelines allowed almost all forms of DR-TB to be treated with either BPaLM or BPaL. Photo: Victor Chavez/Getty Images for TB Alliance
Ndjeka explained that the new WHO guidelines allowed almost all forms of DR-TB to be treated with either BPaLM or BPaL. Photo: Victor Chavez/Getty Images for TB Alliance


The World Health Organisation (WHO) has announced key changes to the way drug-resistant tuberculosis (DR-TB) will be treated after a discovery by researchers from Wits University. This is a significant development that will greatly benefit patients with DR-TB in South Africa and around the world.

The changes include that the treatment time will be cut down from 18 months to six months, the number of pills will be reduced from 23 a day to 23 a week, painful injections will be eliminated and side effects will be significantly reduced.

Under the leadership of Dr Norbert Ndjeka, the department’s of health’s chief director of TB control and management, much of this pivotal research was conducted by Wits and the Clinical HIV Research Unit as part of clinical trials, including studies conducted by the Global TB Alliance.

The research revealed that nine out of every 10 patients treated in line with the new regimen will be cured, offering hope to those who have DR-TB. Through an early access programme, some DR-TB patients in South Africa are already benefiting from the new regimen.

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The trials, which were mostly conducted in South Africa, produced robust data that changed international policy.

Ndjeka explained that the new WHO guidelines allowed almost all forms of DR-TB to be treated with either BPaLM (a combination of bedaquiline, pretomanid, linezolid and moxifloxacin) or BPaL (bedaquiline, pretomanid and linezolid).

Dr Francesca Conradie, an infectious diseases researcher at Wits and principal investigator of the clinical trials, said that, under Ndjeka’s leadership, they had been delivering this treatment to those who needed it most under the BPaL clinical access programme since March last year.

“The timing has been lightning speed from the findings of the clinical trials to the adoption by the WHO of the treatments tested.” she said:

This achievement speaks to South Africa’s TB programme and Ndjeka’s visionary approach to addressing TB, which includes a strong focus on rigorous research.

Conradie added that the field had been rapidly changing and that South Africa had speedily embraced this through its national TB programme.

“The new regimen consists of only three or four medications, namely bedaquiline, pretomanid and linezolid, with the addition of moxifloxacin.”

Groundbreaking research from Wits

Professor Shabir Mahdi, head of vaccinology at Wits, said their researchers continued to produce groundbreaking research of international importance.

“The findings from this study will inform treatment programmes across the world, make treatment of the deadly scourge of TB more tolerable for patients, improve outcomes for patients and relieve pressure on health systems.

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“Additionally, based on data from South Africa’s national TB programme, the WHO has also recommended an alternative nine-month all-oral regimen for the treatment of MDR/RR-TB. In this regimen, an older drug, ethionamide, has been replaced with a newer drug, linezolid. Ethionamide has many side effects that often deter patients from completing their treatment.”

According to the WHO, TB remains a threat to global public health and is one of the leading infectious causes of death globally.

In 2020, an estimated 10 million people developed TB and 1.5 million died from the disease.

Due to the impact of Covid-19, TB infections could increase globally in this year and next year.

“South Africa has once again delivered trailblazing research, which will improve outcomes for patients.” Ndjeka said:

This accomplishment has inspired us to continue our work in addressing the TB burden through research that produces better and shorter treatments that can cure the disease.

The year 2017

Health24 has reported on a quicker, simpler test for TB for people living with HIV in South Africa. The new test uses urine and is more effective than the previous test, which involved sputum.

“South Africa has one of the largest burdens of people living with HIV while also suffering from TB. That specific test is especially used for people with low immunity and low CD4 counts.”

According to the report, people are often too sick and weak to provide sputum when they need results and subsequent treatment as quickly as possible. 

The rapid test mentioned above would not have been possible if it weren’t for local researchers at the University of Cape Town.

“A study conducted a while back determined that using urine for a TB test was more useful in patients with compromised immune systems.”

The year 2018

The SA Government News Agency reported patients with multidrug-resistant tuberculosis (MDR-TB) would be able to receive life-changing treatment as the department of health began its roll-out of bedaquiline.

An article written by Health24 reported that the WHO announced in August 2018 that it would follow South Africa’s bold step of shelving the previous injectable drug and introducing all-oral bedaquiline.

The year 2019

After both survived TB, two women, one from Mumbai, India, and one from Khayelitsha, teamed up to oppose the patenting of a drug that does not lead to hearing loss in TB patients. This is because hearing loss is a devastating side effect of standard treatment used to treat drug-resistant TB.

Unfortunately, the drug bedaquiline, the use of which does not lead to a loss of hearing, would remain out of the reach for many people if the patent was extended.

READ: 5 latest developments in TB research

A study published in March 2019 found that drug-resistant TB can be cured in less than half the usual amount of time, improving the chances of patients completing their treatment.

According to the article, South Africa is already ahead of the pack, having introduced a shorter medication course with bedaquiline.


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