Nearly five years after the approval of new tuberculosis drugs, fewer than 25 patients in the country are on them.
Bedaquiline and delamanid were approved in the US in 2013 to treat patients with extremely drug-resistant tuberculosis (XDR-TB) and multi-drug resistant tuberculosis (MDR-TB). The World Health Organisation (WHO) recommends adding either of them to the MDR-TB regimen.
By 2015 only 5,700 patients in the world were on the drug. In 2017, two-thirds of patients on bedaquiline were in South Africa, where of the approximately 11,000 patients being treated for drug-resistant TB, 7,000 are on the drug, giving them higher chances of survival.
In Kenya, Head of the Division of Leprosy, Tuberculosis and Lung Disease Maureen Kamene, says that only patients with XDR-TB were chosen for the drug pilot.
However, there are plans to expand prescription to patients with MDR-TB, with 300 to 500 patients expected to be put on the drugs every year. Data from the National Tuberculosis, Leprosy and Lung Disease Programme shows that Kenya recorded 3,000 cases of drug-resistant tuberculosis.
“A dose of both bedaquiline and delamanid costs Sh50,000 but we are negotiating to purchase it at Sh40,000,” said Dr Kamene, adding that they anticipate to have 650 patients on the drugs by the end of the year.
Last month, Kenya’s TB programme reduced by half the time patients with drug-resistant TB need to take their drugs after research showed that the drugs can achieve the same cure rate whether taken for two years or nine months.
MDR-TB regimens last 18 to 20 months and are designed to include at least five medicines. The idea is to increasingly replace injectable drugs, which are considered painful and more toxic, with oral medicines.
In Kenya, the government caters for tests and drugs. A six-month treatment regimen for drug-resistant TB costs about Sh1.5 million. Kenya has been receiving drugs for patients with XDR-TB for compassionate use for free from USAID.
TB regimens with delamanid cost between Sh100,000 and Sh450,000 per treatment course at the lowest prices available to developing countries, which is considered unaffordable for governments.
To help with widespread scale-up of drug resistant TB treatment, MSF (Doctors without Borders) is advocating a target price of Sh50,000 per treatment course to make it sustainable without having to rely on donors like the Global Fund or PEPFARr.
The recommended dose for bedaquiline is 400 mg a day for two weeks, followed by 200 mg three times a week for 22 weeks.
The WHO first recommended the use of bedaquiline for treatment of drug-resistant TB in 2013, but uptake remains low, with the medicines remaining inaccessible to almost 90 per cent of people who could have benefitted from them in 2017.
“We have seen too many senseless and painful deaths because people are still not getting access to today’s best-available TB tests and treatments that are more effective and cause fewer severe side effects,” said Dr Gabriella Ferlazzo, TB/HIV advisor with MSF’s Southern Africa Medical Unit.
“Today, only 25 per cent of people with multi-drug-resistant TB are properly diagnosed and treated. People ‘lucky’ enough to start the treatment have to go through a two-year-long painful process, involving nearly 170 injections and more than 12,000 pills, with harsh side effects including deafness, psychosis and even suicide,” he added.