Short-term TB treatments (BPaL)

A six-month tuberculosis treatment plan known as BPaL that was recently chosen over the customary 18-month protocols by scientists was successful in improving the health of 84% to 94% of the sickest TB patients, according to studies conducted in several different nations.

About BPaL

• Bedaquiline, pretomanid, and linezolid are three more recent antibiotics that are combined to form BPaL.
• The three-antibiotic regimen is still undergoing clinical trials in India, where it may be incorporated into the country's TB treatment.
• (3) dosages Pretomanid and bedaquiline, two of the components, are brand-new medications created by TB Alliance and Johnson & Johnson. Linezolid is an ancient generic medication.
• The three medications are authorized in India.
• The BPaL is administered orally.
• WHO: For all types of drug-resistant TB, pretomanid-containing regimens have been approved by the WHO.

Facts

• India has the largest TB burden in the world with 2.6 million active cases and about 450,000 annual TB-related deaths.
• Mumbai is frequently referred to as the centre for drug-resistant TB patients.
• There are more TB patients there than anywhere else in India who are using the more recent, injection-less BPaL short.
• The non-profit organisation TB Alliance is situated in New York and develops and distributes pharmaceuticals to treat tuberculosis (TB).
• XDR-TB: A uncommon form of multidrug-resistant tuberculosis called extensively drug-resistant tuberculosis (XDR-TB) occurs when many of the most potent and essential anti-TB medications are unable to stop the microbiological activity.

Problem with BPaL

• Adverse effects: The proper dosage of these three medications is a major concern because some individuals have experienced side effects from BPaL that have affected their nervous systems and vision.

Relevance of BPaL

• Despite the fact that the majority of BPaL study participants had advanced disease, there has been no fatality.
• The U.S. Food and Drug Administration (FDA) has given the BPaL regimen approval for the treatment of people with treatment-intolerant or non-responsive pulmonary extensively drug-resistant tuberculosis (XDR-TB) or multidrug-resistant tuberculosis (MDR-TB).
• Treatment by mouth: Patients no longer have to endure months of agonising daily injections.

About Tuberculosis

Cause:

• It is brought on by the bacterium Mycobacterium tuberculosis and typically affects the lungs.

Transmission:

• People with lung TB cough, sneeze, or spit, which causes TB to spread via the air.
• Just a few bacteria must be inhaled for someone to become ill.
• A person who contracts TB infection contracts TB bacteria that are dormant in the body. They risk developing TB disease if their immune system deteriorates from this infection.

Symptoms:

• a persistent cough, fever, weariness, weakness, or chest pain.
• Frequently, these symptoms will be moderate for several months, which causes delays in seeking treatment and raises the risk of infecting others.

Diagnosis:

• A sputum sample is taken in order to test for TB bacteria in cases of suspected lung TB illness.
• Samples of the affected body fluids and tissue can be evaluated for non-lung TB illness.
• Rapid molecular diagnostic tests are advised by the WHO as the first testing for anyone exhibiting TB symptoms.
• Chest X-rays and sputum smear microscopy are two more diagnostic methods.

Treatment

• Antibiotics can be used to treat both TB infection and illness.
• The typical 6-month course of four antibiotics is used to treat it. Isoniazid and rifampicin are typical medications.
• The TB bacteria do not respond to the common medications in drug-resistant TB. It takes more time and effort to treat it. Bedaquiline is used to treat it.
• To avoid the onset of disease in cases of infection (when the patient is infected with TB bacteria but is not unwell), TB preventive medication can be administered. A shorter duration of the same medications is used in this treatment.

The Efforts Made:

Global Action

• WHO's Multisectoral Accountability Framework for TB, 1+1 initiative, and Global Tuberculosis Program and Report.

• According to UN SDG objective 3.3, the TB epidemic will be eradicated by 2030.
• The 2017 Moscow Declaration to End TB.

Indian Attempts

• By 2025, the government hopes to have rid India of tuberculosis, five years before the worldwide goal of 2030.
• The National Strategic Plan to End Tuberculosis (TB) by 2025 is based on the pillars of Detect-Treat-Prevent-Build (DTPB).
• Program for Universal Immunization.
• Under the National Health Mission, the National TB Control Program has been revised.
• The TB Sample Transport Network and the NIKSHAY site.
• Creating a national framework for a TB treatment strategy that considers gender.

Difficulties related to TB

• Insufficient staffing at TB facilities has resulted in lower quality and slower care due to the three COVID waves' diversion of human resources within the health system.
• According to studies, COVID may open up pathways that cause dormant TB bacilli to reactivate.
• In the past, social unrest (like war), food insecurity, poverty, and malnutrition have contributed to increases in the prevalence of TB.
• Therefore, it's possible that TB will spread more in the upcoming years.
• Some of the factors closely linked to TB are immunosuppressive diseases including diabetes, malnutrition, and poverty.

India-specific advice

• Not just for TB, but also for health, nutrition, and preventive programs, India needs investment.
• India has to make investments in cutting-edge technology, increase capacity, increase the size of its health personnel, and improve the quality of its primary care facilities.
• As significant components of health services, telemedicine, and remote support must also be taken into account.
• The most crucial step before beginning any of this is to create an open and collaborative platform where all parties, particularly affected communities and independent experts, take the initiative.
• COVID has served as a fantastic illustration of how quick investments and actions may change behaviour.

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