Introducing bedaquiline: experiences from the Challenge TB Project.

Area of Science:

• Public Health
• Infectious Diseases
• Pharmacology

Background:

• Drug-resistant tuberculosis (DR-TB) presents a significant global health challenge.
• The World Health Organization endorsed bedaquiline (BDQ) in 2013 for eligible DR-TB patients.
• The Challenge TB (CTB) project aimed to facilitate BDQ introduction in supported countries.

Purpose of the Study:

• To analyze the processes and outcomes of introducing bedaquiline-containing regimens in 23 countries.
• To identify critical interventions and challenges associated with BDQ implementation.
• To assess the impact of BDQ on patient enrollment and treatment outcomes.

Main Methods:

• Retrospective review of project reports from 2016 to mid-2019.
• Analysis of data on implementation processes, patient enrollment, and interim treatment outcomes.
• Examination of country-level data from 23 Challenge TB supported nations.

Main Results:

• BDQ introduction averaged 2 years, with rapid scale-up in Ethiopia and Kyrgyzstan.
• Key interventions included advocacy, policy revision, healthcare worker capacity building, and laboratory strengthening.
• 9398 patients received BDQ; 71% achieved culture negativity by 6 months.
• Challenges included regulatory coordination, drug quantification, and drug safety reporting.

Conclusions:

• Successful bedaquiline introduction necessitates a systematic, programmatic strategy.
• Initial time investment is crucial for achieving scale-up, coverage, and sustainability.
• National TB Programmes play a vital role in the ownership and long-term success of BDQ implementation.