New TB drug of­fers glim­mer of hope in S. Africa


Drug-re­sis­tant tu­ber­cu­lo­sis is a ma­jor health chal­lenge across much of Africa, but a new medicine be­ing pi­o­neered in South Africa could be a break­through af­ter decades of frus­tra­tion.

Be­daquiline is be­ing made avail­able to 3,000 peo­ple suf­fer­ing side ef­fects of the usual drug-re­sis­tant tu­ber­cu­lo­sis treat­ment, or who have de­vel­oped com­plete drug re­sis­tance.

The early signs are en­cour­ag­ing, doc­tors say, though be­daquiline hasn’t yet been tested in largescale clin­i­cal tri­als.

The new drug — one of the first new tu­ber­cu­lo­sis an­tibi­otics re­leased in 40 years — was first given to 217 South African pa­tients as part of an early ac­cess pro­gram.

Jen­nifer Hughes, a 36-year-old Bri­tish doc­tor in Cape Town, said she has seen the benefits.

Al­ready, word has spread at Hughes’s clinic in Khayelit­sha, a poor town­ship, and peo­ple are com­ing from all over the city re­quest­ing the new drug, de­vel­oped by U. S.- based phar­ma­ceu­ti­cal com­pany Janssen.

“Ev­ery­one has heard that this is where you get bet­ter treat­ment,” said Hughes, who re­calls the “re­ally, re­ally happy day” when her first be­daquiline pa­tient was de­clared tu­ber­cu­lo­sis-free in Novem­ber last year.

South Africa has one of the worst tu­ber­cu­lo­sis epi­demics in the world, with more than 1,000 cases per 100,000 peo­ple and the depart­ment of health de­scrib­ing the rise of drug-re­sis­tant tu­ber­cu­lo­sis as a “ma­jor public health prob­lem.”

“We want to get 3,000 pa­tients on be­daquiline this year, and plans are in place to scale up,” said Nor­bert Nd­jeka, South Africa’s direc­tor of the drug-re­sis­tant tu­ber­cu­lo­sis pro­gramme.

“The drugs are al­ready in a num­ber of our fa­cil­i­ties. Def­i­nitely th­ese drugs will reach the pa­tients.”

The treat­ment is also be­ing used in Rus­sia and has re­ceived con­di­tional guide­lines from the World Health Or­ga­ni­za­tion (WHO).

But clin­i­cal tri­als aren’t con­cluded, and the drug can be pro­hib­i­tively ex­pen­sive — fac­tors that have limited its dis­tri­bu­tion.

Drug Re­sis­tance Grow­ing

Nd­jeka said South Africa was pay­ing ap­prox­i­mately US$1,000 per six-month course of be­daquiline, which can run a hefty price tag of up to US$30,000 in de­vel­oped coun­tries.

Glob­ally, drug-re­sis­tant tu­ber­cu­lo­sis cases are grow­ing so fast that last year the WHO warned that rates were at “cri­sis lev­els.”

Tu­ber­cu­lo­sis, a con­ta­gious bac­te­rial in­fec­tion of the lungs, is one of the world’s most deadly dis­eases, killing 1.5 mil­lion peo­ple in 2013.

Though promis­ing, ex­perts point out that the new drug is not a sil­ver bul­let and has side ef­fects of its own, in­clud­ing liver and heart com­pli­ca­tions.

“The treat­ment we’ve got is not great, but we know what the side ef­fects are,” said An­drew Black, a pul­mo­nolo­gist at the Uni­ver­sity of Wit­wa­ter­srand in Jo­han­nes­burg. “At the mo­ment we don’t know (enough) about the new drug.”

On a Wed­nes­day morn­ing in March, Black was on duty at a drug re­sis­tant tu­ber­cu­lo­sis clinic at the Char­lotte Max­eke Jo­han­nes­burg Aca­demic Hos­pi­tal.

Over 20 peo­ple were wait­ing for treat­ment, all with white masks cov­er­ing their mouths.

Over­head, ul­tra­vi­o­let lights — light kills tu­ber­cu­lo­sis germs — cast a pur­ple glow on the room. Oc­ca­sion­ally, a per­son let out a hack­ing cough.

While the new drug is wel­come, South Africa’s abil­ity to com­bat tu­ber­cu­lo­sis is held back by an over­stretched health care sys­tem, said Black.

Peo­ple of­ten de­fault in their treat­ment be­cause they have to travel so far to a clinic and miss count­less days of work.

Still, de­spite the chal­lenges, Black be­lieves South Africa is mak­ing progress.

“We won’t know if we’re win­ning for a cou­ple of years,” he said, “but it’s not like HIV was, we’re not ig­nor­ing it.”


For­mer tu­ber­cu­lo­sis-af­fected pa­tient Ash­ley McQuire re­ceives his med­i­ca­tion from a nurse in the tu­ber­cu­lo­sis ward of Tshe­p­ong Hos­pi­tal in Klerks­dorp on March 12.

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