ISLAMABAD and PRETORIA (9 November 2023)—The Association for Social Development (ASD) has registered 206 participants with drug-resistant tuberculosis (DR-TB) in Pakistan through a pilot program for treatment with new regimens recently recommended by the World Health Organization (WHO), known as BPaL/M – combinations of bedaquiline, pretomanid, and linezolid, with or without moxifloxacin. ASD reported that out of 113 treatment outcomes declared, so far 105 (95%) have been successful—matching the success rates found elsewhere in the world with these new regimens and a drastic improvement over results with prior drug-resistant TB therapies. As an outcome of these positive results, Pakistan has updated its treatment guidelines for DR-TB to enable the use of these six-month, all-oral regimens.
“The results we have seen with BPaL/M treatments in Pakistan are truly extraordinary,” said Dr. Abdul Ghafoor, MDR-TB Advisor, National TB Program, and lead on the BPaL/M rollout in Pakistan. “This regimen surpassed expectations, demonstrating outstanding efficacy and transforming the lives of patients across the country. We are witnessing higher cure rates and shorter treatment durations, offering renewed hope to patients and their families.”
The WHO considers Pakistan to be a high-burden country for multidrug-resistant TB, with one of the highest caseloads and incidence rates in the world. In May, WHO Director-General Dr. Tedros noted that 109 countries are now adopting all-oral, six-month, BPaL-based regimens (BPaL with or without moxifloxacin)—with much higher cure rates than in the past.
“We are excited to see positive results from Pakistan’s operational research program that will help advance national access to the BPaL/M regimens for drug-resistant TB treatment,” said Sandeep Juneja, Senior Vice President of Market Access at TB Alliance. “People with DR-TB should no longer be left to take lengthy and difficult treatments, often lasting 18 months or longer with no real guarantee of being cured. We are glad to be collaborating with Pakistan’s national TB program and ASD to ensure that BPaL/M reaches those who need it.”
Since October 2022, in collaboration with Pakistan’s National TB Control Program (NTP) and TB Alliance, ASD has recruited participants in four sites in Punjab and Khyber Pakhtunkhwa (KPK) provinces: Leprosy Rawalpindi, Nishtar Multan, Jinnah Lahore, and Lady Reading Peshawar. ASD’s support of the rollout included technical expertise to ensure the treatment’s successful implementation along with the development of comprehensive training materials, adherence guidelines, and performance monitoring tools. The project benefitted from TB Alliance’s global experience in implementing BPaL/M in several countries around the world.
The program's effectiveness is supported by the inspiring recovery narratives of individuals who have received successful treatment for severe drug-resistant infections, thereby improving their overall health outcomes. Ayesha, a young mother, was diagnosed with DR-TB, but she had seen many others in her community get sick and undergo burdensome, lengthy treatments. When she became sick herself, she had a chance to enroll in the pilot program for the BPaL/M regimen. The shorter duration and higher efficacy of the treatment brought quick relief, which allowed Ayesha to regain her strength and actively engage with her family once again. The program's success is underscored by the stories of Ayesha and other participants who have been cured in the face of deadly, drug-resistant infections.
“I had little hope after witnessing the prolonged treatments of people I know who were battling drug-resistant tuberculosis,” Ayesha said. “The BPaL/M treatment emerged as a ray of sunshine in my life, with its completion taking just six months. Thanks to this remarkable breakthrough, I can now be present for my family and relish the simple joys of life once more.”
Her husband, Ali, also shared his gratitude and said, “The BPaL/M treatment has been a true blessing for my wife's health. Unlike many we've known who faced challenges during their treatment journeys, Ayesha encountered notably fewer side effects. Our heartfelt gratitude goes out to the dedicated doctors and organizations who have made this transformative treatment a reality.”
Dr. Amir Khan, Chief Cooperation Professional at ASD, reflected on the significance of this achievement and the partnerships that made it possible, stating, “ASD is committed to tackling the challenges presented by drug-resistant tuberculosis in Pakistan. We’re proud to be part of this groundbreaking initiative, which has been a pivotal moment in the battle against DR-TB. The success we achieved in successfully piloting BPaL/M in Pakistan is a testament to the collaborative efforts of all stakeholders involved, including our partnerships with the NTP and TB Alliance, whose experience and learnings from implementation in other countries was highly valuable.
As the program continues to evolve, ASD remains committed to promoting, supporting, and scaling up the implementation of BPaL/M treatments in Pakistan. Using the insights from these first four sites, the National Program has already begun scaling at eight additional sites across the country and plans to scale to more than 40 DR-TB care sites in Pakistan, ensuring that every person in need can benefit from this program. Earlier this year, TB Alliance also announced another commercialization partnership with Remington Pharmaceuticals, which may also help expand access to pretomanid and the BPaL/M regimens in Pakistan.
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About Association for Social Development (ASD)
Founded in 1995, the Association for Social Development (ASD) is a non-profit organization operating in Pakistan, with a mission to enhance and expand healthcare interventions focused on communicable and non-communicable diseases. Over the years, ASD has gained international recognition in the fight against tuberculosis (TB), earning distinctions such as the Karel Styblo Prize in 2010 and the Princess Chichibu Memorial TB Global Award in 2018. The core mission of ASD is to uplift the social well-being of underserved communities through the development, implementation, evaluation, and expansion of interventions aimed at improving the effectiveness, accessibility, and utilization of healthcare and social services.
The organization conducts research to identify effective strategies. These findings are translated into practical tools, guidelines, and training materials, benefiting healthcare providers and managers. ASD provides technical support to governmental bodies and partner agencies, facilitating the design, planning, implementation, and evaluation of healthcare programs. ASD is unwavering in its commitment to fostering collaborative models involving both public and private sector partners.
ASD's work encompasses pivotal initiatives in TB control and strong partnerships with entities such as the World Health Organization (WHO), Stop TB Partnership, TB Alliance, the National TB Control Program, and various international funders.
About TB Alliance
TB Alliance is a not-for-profit organization dedicated to finding faster-acting and affordable drug regimens to fight TB. Through innovative science and with partners around the globe, we aim to ensure equitable access to faster, better TB cures that will advance global health and prosperity. TB Alliance operates with support from Australia’s Department of Foreign Affairs and Trade, Bill & Melinda Gates Foundation, Foreign, Commonwealth and Development Office (United Kingdom), Cystic Fibrosis Foundation, Germany’s Federal Ministry of Education and Research through KfW, Global Disease Eradication Fund (South Korea), Global Health Innovative Technology Fund, Irish Aid, Korea International Cooperation Agency, National Institute of Allergy and Infectious Diseases, South Korea’s Ministry of Foreign Affairs, Unitaid, and the United States Agency for International Development. For more information, please visit: www.tballiance.org.
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Photo caption: Ayesha, a young mother and DR-TB survivor was treated with BPaL through the Pakistan Operational Research program