India is getting ready to roll out BPaL (bedaquiline, pretomanid, and linezolid) regimen for all multi/extensively drug-resistant tuberculosis patients.

• This is a significant move in the country’s battle against with the new regime indicating good results in countries including Pakistan, South Africa, Ukraine, etc.
• The continuing spread of drug-resistant tuberculosis (TB) is one of the most urgent and difficult challenges facing global TB control.

What is BPaL?

• BPaL is a new all-oral combination of drugs consisting of Bedaquiline (B), Pretomanid (Pa) and Linezolid (L). 
• The new regimen is also expected to be more cost-effective, reducing treatment costs significantly.

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Significance

• Cost Effective: “After the availability of generic bedaquiline cost to TB programmes has fallen – (BPaLM price is US$426 (US$130 bedaquiline, US$238 pretomanid, US$31 linezolid and US$27 moxifloxacin). 
• Enhance Treatment Outcomes: The regimen shortens treatment duration from 18-24 months to about six months and simplifies the process to three daily tablets, compared to the previous regimen of 14 drugs.
• Increase Adherences treatment:  A shorter regimen, such as BPaL, which is all oral and requires lesser doses per day, will make it easier for a patient to adhere to and complete treatments,

Impact on Treatment

• Currently, India’s success rate for MDR/RR-TB is 56%, and 48% for XDR-TB. 
• The BPaL regimen, endorsed by the WHO, aims to improve these rates by offering a shorter, less toxic treatment.
•  According to a recent study, the BPaL/BPaLM regimens have been proven to be more effective, affordable, and less burdensome for patients.

Elimination Strategy

Although patients harbouring MDR and XDR strains present a formidable challenge for treatment, cure is often possible with early identification of resistance and use of a properly designed regimen. 

• Scaling up NAAT (diagnosis) coverage will be an essential element of the strategy.
• Community-based programs can improve treatment outcomes by allowing patients to be treated in their homes and addressing socioeconomic barriers to adherence.

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