Survivors Against TB (SATB) welcomes the Indian Government’s decision to roll out the BPaLM (Bedaquiline, Pretomanid, Linezolid and Moxifloxacin) regimen for all patients with multi and extensively drug-resistant tuberculosis (M/XDR-TB). This marks a significant milestone in India’s fight against TB – one of the country’s severe public health challenges. The introduction of the BPAL regimen can aid thousands of patients struggling with forms of TB that have proven resistant to conventional treatments.
While this is a much-needed advancement, SATB wishes to highlight several critical concerns that must be addressed to ensure the success of this and other regimens and to safeguard the health and well-being of all affected communities:
- Bedaquiline resistance: The emergence of resistance to Bedaquiline, a key component of the BPAL regimen, remains a grave concern. The government must prioritise the study and understanding of this resistance to prevent it from undermining the efficacy of the BPAL regimen. Robust surveillance and research efforts are needed to address this challenge proactively.
- Monitoring side effects: The BPAL regimen, while promising, carries the risk of severe side effects, including potential toxicities from prolonged use of Linezolid. Comprehensive monitoring and support mechanisms must be established to ensure that patients can safely complete their treatment. This includes timely access to medical care and psychosocial support to manage and mitigate these side effects.
- Access and affordability: Ensuring this regimen is accessible and affordable to all who need it is imperative. No one should be left behind due to financial constraints, geographic barriers, or a lack of healthcare infrastructure, including ensuring that patients on this regimen do not face stock-outs and related anxiety. We also urge the government to implement strategies that make the BPAL regimen available to even the most vulnerable populations and those seeking TB care in the private sector.
- Community representation: Wider community consultations are needed on this issue. The voices of TB survivors and those directly affected by the disease must guide and be integral to the decision-making process. Their lived experiences provide invaluable insights that can guide the implementation of the BPAL regimen more effectively. Inclusive dialogue ensures that the treatment rollout is scientifically sound and socially equitable.
“We welcome the introduction of the BPAL regimen as a critical development in the fight against drug-resistant TB. However, it is essential to address the growing threat of Bedaquiline resistance, understand and mitigate side effects, and ensure that access to this regimen is both equitable and affordable. Our community stands ready to support these efforts and ensure that no one is left behind,” says Deepti Chavan, MDR TB Survivor, Patient Advocate and SATB Fellow.
“As a survivor of drug-resistant TB, I know firsthand the challenges of accessing effective treatment. The rollout of the BPAL regimen is a significant step, but we must ensure that all patients, regardless of their background, have equal access to this treatment and that their voices are heard in this process,” says Akshata Acharya, MDR TB Survivor, Author, Theatre Artist and SATB Fellow.