Contact: Natalie Shure, natalie.shure@treatmentactiongroup.org

March 22, 2024 – Universal implementation of the best available treatment for drug-susceptible tuberculosis (TB) stands to cut 6.3 million years off total treatment by 2030, a new analysis released today by the 1/4/6×24 Campaign coalition has found. The report, Getting Better Faster: Delivering on the Promise of New TB Treatments, shows that slow rollout of the new four-month regimen around the world and limited access to TB diagnostics are among the biggest gaps in terms of overall progress toward achieving the 1/4/6×24 Campaign’s central goal: the universal implementation of shorter and more effective TB regimens (as little as one month or once weekly for TB prevention, four months for drug-sensitive TB, and six months for drug-resistant TB,) by the end of 2024.

While the four-month regimen invoked by 1/4/6×24 was endorsed by the World Health Organization (WHO) in 2022, global uptake has been limited. Besides adding 75.9 million months in unnecessary treatment burden, countries’ failure to adopt the updated regimens drives up costs borne by patients themselves: switching everyone to the “4” regimens could save a cumulative $110 million annually in non-medical expenses (such as lost wages and transportation) in India, South Africa, and the Philippines in 2024 alone. Most importantly, “Shorter treatment durations with fewer side effects would give people their lives back,” said Gloriah Kerubo Moses, a TB survivor and member of the Global TB Community Advisory Board (TB CAB). “Undergoing TB treatment was a very difficult time in my life, mentally and physically —TB survivors like me are passionate about 1/4/6×24 because we want a better experience for others.”

The TB advocates and organizations who make up the 1/4/6×24 coalition have indeed improved the landscape for people affected by TB since co-founding the campaign alongside Treatment Action Group (TAG), Partners in Health (PIH), and Médecins Sans Frontières (MSF) in 2022 —wins which are outlined throughout the report. Community advocacy helped expand manufacturing capacity and secure price reductions for “1” regimens, which most countries have laid out plans to scale up. Preliminary numbers suggest the global proportion of people with drug-resistant TB receiving a “6” regimen rose from 6 percent in 2022 to 29 percent in 2023 – thanks in part to longtime activist efforts to expand access to the drug bedaquiline.

Nonetheless, the report identifies key actions still required to attain 1/4/6 within less than a year left before the ambitious campaign deadline, which include:

* All country governments must significantly increase investment in TB;

* The WHO must actively work with countries to facilitate rollout of “4” regimens and to introduce new TB diagnostics

* The Global Fund should cover higher costs of “4” regimens and use its market-shaping power to further reduce prices for drugs and diagnostics;

* Research funders must advance and open enrollment for TB studies involving children and pregnant people to close knowledge gaps that render improved treatments inaccessible to these populations;

* Danaher/Cepheid must expand access to diagnostics by reducing the price of rapid molecular TB tests to $5, including the test for extensively drug-resistant (XDR) TB currently priced at $15; and

*Otsuka and Viatris must substantially reduce the price of delamanid and Otsuka should withdraw all remaining patents.

Finally, country governments and global health actors must take steps to address what the late PIH cofounder Dr. Paul Farmer called the “5 Ss” necessary to deliver quality care in every country: stuff, staff, space, systems, and support. “Addressing structural barriers is essential so that everyone, everywhere gets the care they need,” said David Branigan of Treatment Action Group. “Laying the groundwork for 1/4/6×24 puts us on a path toward finally ending TB for good.”

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