Health Minister Aaron Motsoaledi launched a national pilot project to begin providing a new drug called delamanid to people with drug-resistant TB. (Mike Hutchings, Reuters)

SA continuing to negotiate affordable access to TB drug

Laura Lopez Gonzalez
A new pilot programme launched Friday will allow at least 200 people to access the latest treatment worth hundreds of thousands of rand.

South Africa will begin providing a new drug worth hundreds of thousands of rand to patients with drug-resistant TB. The drug will be provided free – for now – as the government continues to try to negotiate for affordable prices.

Health Minister Aaron Motsoaledi launched a national pilot project Friday to begin providing a new drug called delamanid to people with drug-resistant TB.

The drug, delamanid, is one of the first new TB medicines to be developed in 50 years. In unpublished research by international humanitarian organisation Doctors Without Borders (MSF) delamanid has been shown to cut drug-resistant TB treatment times by two-thirds when used in combination with existing remedies, MSF advocacy and communications officers in Swaziland Zanele Zwane told the Mail & Guardian’s Bhekisisa Centre for Health Journalism in early March.

Current treatments for drug-resistant TB can take up to two years, and patients have to take handfuls of pills daily that put them at risk of deafness or psychosis. More than half of patients with the most extreme form of drug-resistant TB, also known as extensively drug-resistant TB, will die, University of Cape Town studies have shown.

Delamanid’s maker, Otsuka Pharmaceuticals, has agreed to provide the drugs used in the pilot, also called a clinical access programme, for free to at least 200 patients. A six-month course of the drug retails for about R430 000 a patient. The tablets are available at a reduced price of R22 000 per course for some high TB-burden countries, including South Africa.

Wary that the country’s “free ride” will run out eventually, the health department is continuing to negotiate with Otsuka for cheaper access to the drug, says Yogan Pillay, department of health’s deputy director general for HIV, TB and maternal, child and women's health. Pillay was speaking at a Mail & Guardian Critical Thinking Forum held Thursday east of Johannesburg.

He explains: “We’re working with them on registering the drug for use against TB as well as the price because at the moment it’s quite unaffordable. So far, they’ve given it to us for free with the hope that we’ll expand our use of it and they will recoup their “R&D” [research and development] costs, as they call it.

“We are quite keen to work with them because we think it’s a useful drug to have.”

Pillay says they are also working on increasing the number of patients that can receive the drug as part of the new pilot programme.

In 2015, more than 20 000 people in South Africa were diagnosed with TB that no longer responds to commonly used medication, according to World Health Organisation (WHO) figures.

Delamanid is one of two new drug-resistant drugs, alongside bedaquiline, to be introduced in South Africa in recent years. As of February, South Africa now leads the world in the number of patients that have received bedaquiline, show figures provided by the international humanitarian organisation Doctors Without Borders (MSF).

Pillay says the country also leads the world in the number of people at risk of TB that are receiving medication to prevent it, also called isoniazid preventative TB therapy (IPT). The therapy works by using a common TB treatment drug, isoniazid, to prevent people from developing TB.

Almost 60% of patients on IPT globally now call South Africa home, he explains. Pillay credits this with helping the country to almost halve new TB cases and deaths in the last eight years.

In a 2010 study published in the journal AIDS, researchers found that IPT halved the risk of TB among people living with HIV, who are between 20 to 30 times more likely to develop the disease, says the WHO.

South Africa is expected to launch its new national TB and HIV strategy on 31 March. The document is expected to include focuses on reaching youth, adolescents and high-risk groups such as miners with better TB testing and care. 

Tuberculosis (TB)

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