New TB regimen to shorten treatment and improve compliance

A new anti-tuberculosis regimen will be rolled out in South Africa which will see high-risk patients taking fewer pills, less often, and for a shorter period.

Developed by the Aurum Institute, the development project involved a study into the proposed regimen in three high risk countries, including South Africa, where over 4000 patients with HIV were treated on monitored. Other countries involved in the TB preventive therapy study were Ethiopia and Mozambique.

The study found that after a year, patients on the new, shorter, three-month regimen were far more likely to complete their treatment rather than on the longer regimens which were for six months and 36 months respectively.

Professor Gavin Churchyard, group CEO of the institute and head researcher for the study, says their regimen referred to as 3HP comprises taking two drugs to fight the infection instead of one. Isoniazid, which is a standard TB treatment is taken with rifapentine, a newer and powerful drug, which shortens which only needed to be taken for three months.

Churchyard said: “Whereas with just the isoniazid by itself you would have to take it daily for six months, we have managed to drastically reduce this time and the pill burden for everybody because it does not have to be taken continuously which has been a challenge for particularly young children and those who are already on antiretroviral (ARV) treatment.”

According to Vuyolwethu Gonela, deputy general secretary of the Treatment Action Campaign in South Africa, the outcome of this study has been long-awaited in the HIV/AIDS community.

“We as the community of people living with HIV really appreciates the outcomes of this study and we have been waiting for this outcome for a really long time. The current situation is that there is more of a pill burden on people who are on this treatment, especially those who are living with HIV and are already taking lifesaving medication every day.

“It is now up to government to initiate a consultation process which will eventually lead to the development of policy around the roll-out of the regimen. We need to get together in order to develop guidance on how this will be rolled out in the public health system and any criteria around how people are put on the treatment.”

Until now, doubts have lingered about how long the protection of 3HP in high-burden TB settings lasted, which had implications for its planned wide-scale roll-out.

“We have done mathematical modelling in order to project the impact this intervention will have and in South Africa where may people are HIV positive and at risk of developing the TB disease even if they are on antiretroviral treatment – if they are taking it in addition to the TB treatment it reduces their risk of contracting TB dramatically and they are more likely to complete the treatment.”

Completion of the treatment course in the combined 3HP arms (3,610 people) versus isoniazid (404 people) arms was 90.4% versus 50.5%, respectively.

Professor Katherine Fielding, from London School of Hygiene; Tropical Medicine and senior statistician on the study, said: “When we’re asking people who are not sick to take medicines, adherence can be a huge problem.

“This study confirms what we already suspected—that it’s easier for people to take pills once a week, for three months, than once a day for six months. Shorter regimens lead to higher adherence, which ultimately improves treatment outcomes.”

Churchyard added that almost a quarter of the globe had latent TB infection, though many live with no TB symptoms, are not contagious, and most of them don’t know they are infected.

If left untreated, latent infection can develop into active TB, which is contagious.

“Latent TB infection is the breeding ground for the TB epidemic, and preventing new cases is critical if we want to end the TB epidemic,” said Churchyard.

– Simnikiweh@citizen.co.za

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