arcTB: A Patient-Focused Tuberculosis Treatment Initiative

In 2021, Elvis Espinosa was diagnosed with multidrug-resistant tuberculosis (MDR-TB) and warned by his clinicians in Peru that the road ahead wouldn't be easy. His treatment consisted of a routine of up to 16 pills a day, accompanied by painful injections. Even after months of diligently adhering to this regimen, Espinosa felt no relief and was rapidly losing weight-dropping from his usual weight of 183 pounds to just 95.

Espinosa's disease had progressed to an even more complex form of tuberculosis (TB), pre-extensively drug-resistant TB (pre-XDR TB), which is resistant to several additional medications, and he began to lose hope. He returned to his birthplace-La Oroya-with his family to say goodbye to the place he grew up, thinking he would soon die.

Then, an initiative from Socios En Salud, as Partners In Health is known in Peru, changed everything.

Elvis Espinosa holds his saxophone, an instrument he thought he'd never touch again after he was diagnosed with extensively drug-resistant tuberculosis. Photo by Diego Diaz Catire / PIH

An Innovative Approach to Tuberculosis Treatment

At the height of Espinosa's illness, the Socios En Salud team met him at a local health clinic, reviewed his TB records, and proposed a new treatment plan. He would only need to take four pills a day-a groundbreaking all-oral regimen that had been recommended by PIH-led research.

The six- to nine-month regimen of four all-oral drugs-bedaquiline, delamanid, linezolid, and clofazimine-was found to be a shorter, safer, and more tolerable treatment for the most resistant form of TB, compared to standard treatment of up to 18 months with injectables and severe adverse effects that hadn't been helping Espinosa.

With each month of the new regimen, his body finally began to recover. Around the world, clinicians were seeing similar results in their patients experiencing drug-resistant TB (DR-TB).

To build on the success of this improved treatment for patients like Espinosa, and accelerate its implementation in countries with a high burden of TB, Partners In Health and Unitaid launched the Accelerating Regimens and Care for DR-TB (arcTB) project to strengthen diagnosis, prevention, and treatment in Belarus, the Democratic Republic of Congo, Kazakhstan, Liberia, Pakistan, Peru, and South Africa.

The arcTB Project

With catalytic funding of $7.3 million from Unitaid-an organization long committed to advancing innovation in the fight against DR-TB-arcTB is led by PIH in collaboration with a consortium of leading global health partners. Médecins Sans Frontières, IRD Global, and Stellenbosch University are PIH's consortium partners for the implementation of arcTB, delivering patient-centered care across the seven high-burden countries. Programmatic and diagnostic capacity will be enhanced through the technical expertise of Harvard Medical School and the Institute of Tropical Medicine Antwerp, supporting the rollout of the latest WHO-recommended tools and strategies for DR-TB care.

The new DR-TB regimen. Photo by Aminata K. Massaley / PIH

Despite being preventable and curable, tuberculosis remains the world's deadliest infectious disease, killing 1.3 million people annually. Alarmingly, only one in four DR-TB patients are diagnosed and successfully treated-highlighting the need for investments like arcTB.

Over the next three years, arcTB will enhance case detection, connect patients to preventive and curative services, and improve the quality and availability of treatment, especially among children and pregnant women. In arcTB, every person diagnosed with active DR-TB will be offered the latest all-oral DR-TB treatments that Espinosa received.

"Too many patients are lost at every point along the care cascade-from recognizing symptoms to accessing testing to receiving the right treatment," said Dr. Michael Rich, senior health and policy advisor at PIH. "arcTB is about breaking down those barriers-bringing testing closer to communities, simplifying treatment, and ensuring that care is not just available, but compassionate and complete. When countries get this right, TB can decline by more than 10 percent per year. That's not just progress-that's a path to elimination."

Already, Partners In Health teams in Kazakhstan, Liberia, and Peru have begun strategizing alongside local partners and ministries of health to implement the work outlined in the arcTB project. As the project continues to grow over the next few years, advances in TB treatment will reach those around the world who need them most.

arcTB is building on PIH's legacy of innovative DR-TB care, from its cutting-edge care for DR-TB patients in Peru's slums in the 1990s to its leadership in developing new and improved treatment regimens in the 2020s. arcTB marks the next step in PIH's mission to ensure impoverished and marginalized people everywhere-like Elvis Espinosa-have access to the best TB care, bringing us closer toward a TB-free world.