Doctors Without Borders has fought against TB for many years. In 2019, Doctors Without Borders started 18,800 people on TB treatment, including 2,000 people with drug-resistant TB (DR-TB).
The settings in which Doctors Without Borders provides TB care vary widely. They include areas of chronic conflict, such as Chechnya; refugee camps in Chad or Thailand; prison settings in Kyrgyzstan; and countries with overburdened health systems such as Papua New Guinea.
The focus of the projects also varies: some concentrate on integrating HIV and TB services, such as in South Africa and Kenya; others offer treatment to patients suffering from DR-TB, as in Uzbekistan and Georgia; others reach out to particular populations who have little access to medical care, such as migrants in Thailand.
Doctors Without Borders is striving to improve diagnosis of all TB patients, by introducing tools such as a urine-based test called TB LAM, which is rapid, inexpensive, and easy-to-perform without electricity or instruments. Due to its lower sensitivity (which means that it misses many positive diagnoses) TB LAM cannot replace other tests, but in combination with GenXpert MTB/RIF and TB-LAMP, it can help diagnose TB cases in people living with HIV that would have otherwise gone undetected.
Another important tool is drug susceptibility testing (DST). The treatment of drug-resistant TB (DR-TB) requires DST to ensure people with TB disease are not treated with medicines against which their bacteria are resistant.
In terms of treatment, Doctors Without Borders is currently exploring different ways of ensuring patient adherence, and is committed to using fixed-dose combinations and quality-assured drugs in its programmes. Doctors Without Borders also aims to integrate TB and HIV services where possible, and to treat drug-resistant TB in appropriate settings.
Clinical Research and Trials
There are quite a few challenges in addressing TB. Most of the drugs used to treat TB have been around for decades. Some were not even originally developed for TB use, or have toxic side effects. Another challenge is that TB treatment takes a long time, up to two years for DR-TB; and research into new, shorter, more effective drug regimens is urgently needed.
Doctors Without Borders is participating in two clinical trials, EndTB and PRACTECAL, to find new treatment regimens. Both trials enrolled their first patients by the end of March 2017.
DR-TB is a particularly worrying and growing problem in many of the places where Doctors Without Borders works. To improve chances of survival, Doctors Without Borders is conducting crucial research together with partner organisations to develop the evidence base for the therapeutic value of newer DR-TB treatments.
Most drugs to treat TB are old and have toxic side effects. But in the last decade, three new TB drugs were developed—bedaquiline, delamanid and, more recently, pretomanid—giving patients hope and treatment providers options.
When bedaquiline was first authorised for use in 2012, it was the first DR-TB drug to be developed in more than 40 years. But by late 2018, only 28,700 people had received it worldwide; that’s less than 20% of those who could have benefited from it.
Doctors Without Borders spoke out in 2018 to urge Johnson & Johnson (J&J), the pharmaceutical corporation that holds patents on bedaquiline, to take swift action to ensure affordable access to the drug for everyone who needs it to survive. In July 2020, after 120,707 people signed petitions urging the corporation to drop the price, J&J announced a reduced price of US$1.50, 32% lower than the previous lowest price. But this price is only available to a list of countries determined by J&J, and tied to purchase commitments made through the Global Drug Facility (GDF), an organisation run by the Stop TB Partnership that supplies TB drugs to low- and middle-income countries. Doctors Without Borders is still calling on J&J to further reduce the price of bedaquiline and offer it to all countries with a high DR-TB burden, so that more lives can be saved.
Through Access Campaign, Doctors Without Borders continues to call on and pressure governments and pharmaceutical companies to live up their commitments to address TB to save lives and reduce suffering and death from this terrible disease.