The TB burden reached an increase in incidence and mortality rates—the first increase after 20 years of progress
The TB burden reached an estimated 10.6 million cases in 2021, with an increase in incidence and mortality rates—the first increase after 20 years of progress. The burden of drug-resistant TB (DR-TB) is also estimated to have increased in 2021, reaching 450,000 new cases of rifampicin-resistant TB. Equitable access to the best available DR-TB treatments is still suboptimal – despite the introduction of bedaquiline in 2012 and delamanid in 2014, and an expectation of rapid adoption of shorter, less toxic and more effective treatments. Mortality has remained high with 191 000 deaths in 2021.
The pandemic has had a major impact on TB, decreasing case detection and reducing the number of people on treatment. TB continues to be one of the largest contributors to the crisis in antimicrobial resistance (AMR). To reverse setbacks and to address the growing problem of drug resistance, it will be important and a high priority to improve detection tools and accelerate adoption of new drugs in the context of quality care.
Newly recommended and pipeline regimens could fundamentally change drug-resistant (DR) TB care. One regimen, BPaL/M[1], was recommended by WHO at the end of 2022[2], cutting treatment time by 50%. Additional pipeline regimens include those investigated in Unitaid’s endTB project[3] with anticipated evidence to be published at the end of 2023. These regimens could provide better alternatives for persons ineligible for the BPaL/M regimen. Key drugs in these new and pipeline regimens include bedaquiline, pretomanid, and delamanid.
To encourage rapid uptake, WHO issued a Call to Action to accelerate the implementation of the novel, 6-month all-oral regimen for the treatment of drug-resistant tuberculosis. [4] Many high-burden country governments, with other stakeholders involved in the global response, are already advancing towards programmatic roll-out of at least BPaL/M.
Unitaid and other global health and development partners are actively engaging and coordinating on the best strategies for timely and broad access to the shorter and better regimens including leveraging the work of Unitaid’s current investments in TB. Unitaid-funded work includes driving TB detection to primary and community levels, integrating digital technologies and adherence support into TB programs, enabling targeted next-generation sequencing for resistance surveillance and clinical decision-making, optimizing drug-resistant treatment for children, and market shaping to support affordable and timely supply. Even with these efforts and the efforts of the global community to accelerate the programmatic scale-up of better, shorter regimens, several gaps and challenges remain. The ultimate goal is to create conditions for the best health outcomes by enabling people-centred and community-driven approaches to find and get more people into quality care. Unitaid recognizes civil society leadership and meaningful engagement with communities as critical for responsible demand creation, including understanding care-seeking (and barriers to access), increasing diagnostic and treatment literacy, and ensuring responsible use of new drugs and regimens.