By Catherine Murombedzi
Recent research has shown that TB treatment can be cut from six to two months for many patients. This is possible with regimens combining standard and repurposed drugs: Initial findings of Truncate-TB study presented in November 2022 revealed the giant leap in TB treatment.
A promising study presented at the virtual meeting by the Union World Conference on Lung Health 2022, the TRUNCATE TB trial, has revealed that some people who have TB can be treated in as little as two months, as opposed to six months of treatment that has been the standard of care in most countries since the 1980s.
The rationale behind the TRUNCATE TB study, according to Erlina Burhan, a TB expert from the Faculty of Medicine Univeritas Indonesia, is that we are over-treating majority of people who have drug-susceptible (DS) TB (DS-TB) who would actually be cured before the 6-month mark, to prevent relapse in a minority of people who would need the long treatment regimen.
This eye-opening study has revealed that the standard six-month treatment is actually over-treating a lot of people who have TB, which is the world’s leading infectious killer.
According to the statement, the TRUNCATE-TB Trial is a randomised controlled trial conducted at 18 sites in five countries (Indonesia, the Philippines, Thailand, India, and Uganda) and coordinated from Singapore.
The trial investigated a treatment strategy comprising an initial 2-month treatment course (using regimens combining standard and repurposed drugs intended to boost regimen sterilising efficacy), followed by close monitoring and early retreatment of relapses. A total of 674 trial participants were recruited from March 2018 to March 2022 from these 5 countries.
Trial participants were initially given eight weeks of treatment, with the option of extending treatment to 10 or further to 12 weeks, if they had persistent clinical disease after the eight-week treatment. If there was still active TB after that, participants were switched to the standard six-month treatment.
It was noted that the overall death rate was lower and there was no difference in the death rate between the standard treatment arm and the TRUNCATE strategy arms.
The Stop TB Partnership, has supported with capacity development leading to the formation of
TB Survivors in Zimbabwe.
The TB Survivors Network has support groups nationally, with Maureen Masanzu from Mashonaland Central being the elected Chair.
All the 10 provinces have chapters. In Harare, where the writer lives, the Survivors Networks are vibrant. They welcomed the shorter treatment and said it was set to change the national TB response.
The Secretary for the Harare Chapter, Patricia Kafzura was over the moon.
“I am excited to hear of the shorter two months of treatment. It is welcome relief. It’s an achievement because it reduces pill burden,” said Patricia Padzura.
“Looking at this research that shows that the 6 months treatment was over treating a patient, at 2 months of the effectively combined regimen, defaulting will be minimised,” added Padzura.
A community health educator from Dzivarasekwa, Harare was also ecstatic to hear the news. She said the shorter treatment will make monitoring easier.
“Thanks to research and science, who would have ever imagined this? Two months is very good, as it makes monitoring much easier for Health care workers and peer educators in the communities ” said Patricia Dzama, a TB community champuon from Dzivarasekwa, Harare.
Stanley Sibanda, the Harare District Secretary General, who volunteers at Dzivarasekwa Poly Clinic in Harare was pleased that the money used in the long treatment schedule would go to other pressing needs.
“It is a good initiative as it will not only reduce the pill burden but time which the patient visits clinics for collection. This will be a major milestone indeed considering where we started. The cost, too, will be cut with funders able to channel the money to other pressing needs,” said Stanley Sibanda.
Joanna Kasirori, a headmistress in Harare, is a TB/HIV advocate from the Western District.
She has lived with HIV for over three decades.
“I was diagnosed with HIV in 1990 when my husband was admitted to Parirenyatwa Hospital. He had TB. He would take a handful of anti TB drugs. Sadly, we lost him a year later. I am glad that science remains at work and that the dynamic changes ease the pill burden. Adherence to treatment will be observed, too, resulting in few or zero TB related deaths. Early diagnosis remains pivotal, coupled with prevention,” said Kasirori.
Rev Maxwell Kapachawo, a TB Champion from Harare South, welcomed the news.
“To say I am happy is not enough. Pil burden and the long treatment schedule resulted in some people missing doses. As one missed doses, drug resistance creeps in. A person with drug resistant TB (DRTB) passes on that strain. DRTB requires more virulent drugs and takes longer. I am happy that researchers have come up with a shorter treatment,” said Rev Kapachawo.
Questions sent to the Ministry of Health and Child Care on when the shorter regimen would be available were not answered at the time of going to print.
Ending TB is a multi-sectoral approach. With TB Survivors leading the monitoring, the TB response will be better informed for positive outcomes to inform policy makers, partners, and stakeholders.
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