Scientists Working to Reduce Duration of TB Treatment

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Researchers at Epicentre Mbarara in collaboration with St George’s University of London and the INTER-TB Consortium are working to reduce the length of TB treatment from the current six months, to four months under an international study called RIFASHORT Trial.

Dr. Daniel Atwine, the Principal Investigator (PI) of the study at the Ugandan site in Mbarara, said that the study aims at achieving this goal by increasing the dose of Rifampicin, which is the major of the four TB drugs.

“Rifampicin is an effective drug which kills the TB organisms fast, can make the patient non-infectious as it kills the organism in the lungs. It is currently being given throughout the whole six months of treatment, but in low quantities. Researchers believe that by increasing the dose of this drug to almost double or triple of the current dose, they could be able to shorten the treatment to four months,” Dr Atwine said.

He explained that the study targets enrolling 164 participants who will each be followed up for 18 months. He added that since its start in 2017, the study has enrolled 100 participants from various parts of South-western, Uganda.

Dr Atwine further said this research will be very beneficial to Uganda, through providing a more realistic, short and effective TB treatment strategy for the average Ugandan patient.

“Reducing the treatment period cuts on the indirect cost of care, especially since the patients have to travel long distances every month to pick their medicine. Another thing, we have patients with other chronic diseases which require medication too, so reducing the period of TB treatment at least would relieve them from polypharmacy - using multiple medications at the same time,” explained Dr Atwine. 

He also added that having a shorter treatment period would encourage patients to complete their treatment.

“If patients do not take their medicine well and completely within the first six months, they run a risk of the TB organisms getting used to the drugs and resisting them. This condition is called Multi-Drug-Resistant TB (MDR-TB) and is harder to treat,” Dr Atwine said.

Defending the strategy of using high doses of Rifampicin, Dr. Atwine explained that it has been used before in other studies around the world, including Uganda, and was found to be safe.

RIFASHORT Study is in line with the United Nation’s Sustainable Development Goals (SDGs) which include ending the TB epidemic by 2030, under goal 3. The research is also well coordinated with the “End-TB strategy” which involves reducing the number of TB deaths by 95%, reducing TB incident rates by 90%, as well as putting to zero all costs at household level that are brought about by TB, all by the year 2035.

Tuberculosis (TB) is a bacterial infection that attacks the lungs. It is spread from one person to another through air, and is among the top 10 causes of death worldwide.

Symptoms of TB infection include a cough with sputum containing blood, drastic weight loss, pain in the chest, and a bad cough that lasts 3 weeks or longer, among others. The most vulnerable to TB infection are children below age of five, the poor, and people living with HIV.

In Uganda, TB prevalence stands at 253 per 100,000 people, and registers over 5,000 deaths per year according to Uganda National TB Survey 2014/2015. According to World Health Organisation, Uganda is one of the 30 countries in the world with the highest burden of TB and HIV.

Today, treatment for TB lasts six months in which a patient is given four major drugs - Rifampicin, Pyrazinamide, Ethambutol, and Isoniazid. For the first two months, a patient visits the hospital once every two weeks.

According to Dr. Edwin Nuwagira, a medical officer at Mbarara Regional Referral Hospital, TB patients are often discouraged by the current length of treatment.

“When treating TB, we require every patient to have a treatment supporter who helps ensure the patient takes the drugs there and then. However, even with the treatment supporters, some patients still give up and abandon the drugs along the way, because six months is a long time. If the treatment period is shortened it would improve the adherence,” he said.

TB bacteria is capable of staying in the lungs without showing symptoms or signs, thus, the only way to beat it is by adhering to the drugs.

Dr. Viola Ninsiima, the in-charge at Bushenyi health centre IV in Bushenyi district said shortening the TB treatment span would reduce on the pressure faced at local health centre levels.

“Shortening of TB treatment duration from six to four months will be helpful in lifting pressure exerted on health systems which are already over stretched especially those of poor resource settings where TB also occurs the most”, Dr Ninsiima said.

RIFASHORT study is being conducted in parts of Africa, South America, and South Asia.