Kenya cannot afford important tuberculosis drug

Due to its high cost the new TB drug,  has reached fewer than 200 patients worldwide,  two years after it was approved

 Joyce Chimbi @JoyceChimbi

Jackie Akinyi is one of the estimated 90,000 Kenyans who were treated for tuberculosis last year. Experts say that the country has made good progress in the fight against TB.

As is the case for all  TB patients, Akinyi’s  tests and drugs for both drug sensitive and drug resistant TB are catered for by the government. A six-monthstreatment regimen for drug sensitive TB costs about Sh 8,000 per patient and about Sh 1.5 million for drug resistant TB.

“I have been productive since I was put on medication and there is nothing I cannot do now that I used to do before being infected with TB,” says the mother of two.

According to Dr Enos O, Masini, head of programme at the National Tuberculosis, Leprosy and Lung Disease Programme, in the past ten years about 1.2 million Kenyans have been diagnosed with TB with 90 percent successfully treated and over half a million deaths averted through early and prompt treatment.

“Though TB is the fourth leading cause of death in the country, drug resistant TB patients treated in Kenya have much better outcomes than in many other parts of the world, with an 80 percent treatment success rate compared to 40 percent globally,” says Dr Masini.

Dr, Stephen Wanjala, deputy medical coordinator at the Médecins Sans Frontières (MSF) says  the positive outcome notwithstanding, “It is a high priority issue that we have new, effective drugs available through consistent research and development by pharmaceutical companies.”

This is especially true in countries such as Kenya where there is also a high prevalence of HIV/AIDS co-infected people that are at even further risk of unsuccessful outcomes of TB treatment,” he says.

In the same breath, International medical humanitarian organisation MSF has decried the high cost of the new TB drug delamanid which is expected to retails in some developing countries at about Sh 170,000 per treatment course.

Delamanid should be taken with several other drugs to effectively treat drug-resistant TB.

The regimens, without delamanid, already cost between Sh100, 000 and Sh 450,000 per treatment course at the lowest prices available to developing countries, which is unaffordable for governments.

To help with widespread scale up of Drug Resistance TB treatment, MSF is advocating a target price of Sh 50, 000 per treatment course.

Kenya’s first three Extensively Drug Resistant cases were diagnosed by MSF and the Ministry of Health in 2014.

Kenya, as any other country with Multi-Drug Resistance and Extensively Drug Resistant patients, should be considered a priority country.

Dr Masini explains that delamanid became the second new TB drug after bedaquiline to be approved in over forty years to treat multi-drug resistant TB in April 2014.

“The World Health Organisation recommends adding bedaquiline or delamanid with Multidrug-Resistant TB regimen and four effective drugs cannot be designed for patients with high risk of poor outcomes,” he expounds.

However, the availability and uptake of delamanid has been limited, he says.

Nearly two years post approval, the drug has reached fewer than 200 patients worldwide.

Otsuka Pharmaceuticals, the drug manufacturer has registered the drug in the European Union, Japan, and South Korea—areas in which relatively few people with MDR-TB live. Registration is pending in China and Hong Kong.

“There are a handful of patients receiving delamanid in South Africa. Nigeria offers Bedaquiline to less than 10 patients under compassionate use,” says Dr Wanjala.

But the outcry regarding the high price of delamanid notwithstanding, Dr Wanjala says  the country needs to ensure funding becomes sustainable and to rely less and less on Global Fund and PEPFAR.

Kenya also needs to reinforce its diagnostic capacity for both TB and Drug Resistant TB, train staff on managing Multi-Drug Resistant and extensively drug resistant patients. More efforts are needed to win the battle but we cannot say that Kenya is losing the fight against TB,” he concludes.

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