From 2019 to 2023, the Unitaid funded ASCENT project had presence in 5 countries across 3 continents: Ethiopia, Ukraine, South Africa, the Philippines and Tanzania. During this period, the project supported over 19,000 people with their tuberculosis (TB) treatment course through the use of Digital Adherence Technologies (DATs).
By the end of 2023, data collected during this trial showed that DATs hold high acceptance and engagement rates across project regions, as well as served as a tool to tailor the care cascade for people with TB (PwTB) using the DATs. This revealed the potential of DATs as elements of a comprehensive approach to TB care more than a standalone solution to adherence.
New challenges and opportunities
To date ASCENT has been conducted with the focus placed mostly on Drug Sensitive TB (DS-TB). However, over the course of the project, rethinking optimal care for TB took different avenues as new challenges and opportunities arose:
- High rates of people with Rifampicin Resistant/Multidrug Resistant TB (RR/MDR-TB) both treated and untreated: According to the WHO Global TB Report 2023, 825,000 people were treated for RR/MDR-TB between 2018 and 2022, a figure that only represents 55% of the target set for that period; and
- The development of shorter regimens for RR/MDR-TB and its introduction to WHO updated guidelines in 2022: In this document, WHO included a 6-month regimen of BPaLM (Bedaquiline, Pretonamic, Linezolid and Moxifloxacin) in its recommendations to improve treatment and care for people with RR/MDR-TB. Consult here: WHO consolidated guidelines on Tuberculosis, 2022 update.
Making sure people have access to the new treatments will help optimize the care provided to people with RR/MDR-TB, and in consequence a potential improvement of their treatment outcomes. Inadequate management, leading to treatment interruptions, may result in unfavorable individual outcomes and the emergence of TB strains resistant to these regimens. Therefore, key conditions for these regimens’ success require enabling individuals to adhere to the complete treatment course and promptly identifying and managing potentially dangerous adverse events. This will help these treatments work better and stay effective for future patients.
The elements on the RR/MDR-TB care cascade required to drive the positive impact of the aforementioned shorter treatment regimen form the foundation of the extended scope of ASCENT project for the period 2023-2025. See the figure below for an overview of the needs that guided the extended scope of the project.
ASCENT DR-TB
The extended ASCENT project (ASCENT DR-TB), with added funding, will boost its original goal to lower the impact of TB by decreasing cases, deaths, and financial burdens. It will do so by creating the conditions for accelerating the adoption of safer and more effective RR/MDR-TB regimens in the context of a comprehensive quality care package in 8 countries through:
- Tailoring assistance: ASCENT DR-TB will work with partners to address gaps identified during assessments, complementing their activities and resources, avoiding duplicate efforts. Country roadmaps will be updated and specific support will be offered for implementation and scale-up of RR/MDR-TB regimens within a comprehensive care framework.
- Community partnerships: community structures will be supported to raise awareness, enhance treatment literacy by PwTB, and advocate for accessible and person-centered care. This project will also complement other projects that are advancing work led by communities and civil society.
- Stakeholder engagement and capacity building: Through coordination, ASCENT DR-TB will share best practices to hasten the global, regional, and project-country adoption of novel RR/MDR-TB regimens.
- Market shaping: Interventions in collaboration with participating countries and organizations will shape markets to ensure global affordability of WHO-recommended diagnostics and essential drugs.
ASCENT DR-TB project is currently being implemented in 8 countries: Ethiopia, the Philippines, South Africa, Ukraine, Indonesia, Mozambique, Nigeria and Vietnam.
While all countries are gearing up for the programmatic use of BPaLM regimens, they vary in their implementation progress, requiring support at different levels with specific technical assistance needs. ASCENT DR-TB will tailor supportive actions to achieve the best outcome per country context, and ensure relevant work of Unitaid’s projects is supporting a holistic approach and best outcomes.
Stay updated on ASCENT DR-TB website HERE