DRUG PRICE CUT TO SCALE UP FIGHT AGAINST TB

LENGTHY negotiations ended in good news recently when the price of rifapentine, a lifesaving antibiotic, was marked down by 66% by its manufacturer, Sanofi.

When combined with another antibiotic (isoniazid), rifapentine can prevent tuberculosis (TB). The move was announced at the Union World Conference on Lung Health in October 2019.

Talks to lower the price from US$45 to US$15 for a three-month course took more than a year to complete and involved Sanofi, Unitaid and the Global Fund to Fight Aids, Tuberculosis and Malaria, in collaboration with the Stop TB Partnership’s Global Drug Facility and the US’s Pepfar initiative.

Now we – those of us who have been working to bring preventive therapy to the people whose lives depend on it – must roll up our sleeves and make it happen.

Advocates have been pressing for the price of rifapentine to be lowered ever since scientific proof of its effectiveness was published in peer-reviewed journals. Three months of treatment with rifapentine plus isoniazid was shown to be just as effective and less toxic than one year of therapy with isoniazid alone (the previous standard). The reduction in treatment time alone provides an obvious improvement.

The obstacles to getting more people treated begin with locating those at greatest risk and then expanding capacity in preventive treatment programmes to serve them.

TB is one of the top 10 causes of death from an infectious agent worldwide, killing approximately 1.5 million people in 2018. The disease hits especially hard in impoverished regions, where poorly ventilated and overcrowded living and working conditions, inadequate nutrition, the prevalence of other diseases like HIV, and insufficient or non-existent health care all make it far worse than it could be.

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TB is one of the top 10 causes of death from an

infectious agent

Most TB cases in 2018 were in South-East Asia (44%) and Africa (24%). Combined, the two regions accounted for nearly two thirds of all the world’s TB cases.

TB is highly contagious and spread by a cough or sneeze. Family members and other close contacts of people with the disease are at the highest risk of infection.

People who contract TB don’t always get sick immediately. Instead, a TB infection can lie dormant for years until other stresses activate it.

In February 2018, the World Health Organisation (WHO) reviewed its guidelines for preventing TB disease. The guidelines now include three months of rifapentine and isoniazid taken weekly for people living in countries with a high TB burden. This regimen is known as 3HP.

The WHO recommends that anyone living with HIV and those living in the same household as a person with TB disease should receive TB preventive therapy.

Importantly, a 3HP regimen can be administered along with dolutegravir, a better antiretroviral drug which is now being provided in South Africa and globally. The combination is an effective tool for keeping vulnerable people as healthy as possible.

Churchyard is an honorary professor of the School of Public Health at Wits University and chief executive of the Aurum Institute. This article was first published in The Conversation