Real-World Success in Nigeria: Six-Month Regimens, Accelerated by PeerLINC

A new programmatic review from Nigeria’s Southeast zone adds encouraging real-world evidence to the growing body of data on six-month, all-oral BPaL/BPaLM regimens for drug-resistant TB. Analyzing routine care between November 2023 and October 2024, the study followed 212 patients: 202 with MDR/RR-TB treated with BPaLM and 10 with pre-XDR TB treated with BPaL.

Treatment success reached 89% among people with MDR/RR-TB receiving BPaLM and 100% for the smaller pre-XDR BPaL cohort. Loss to follow-up and mortality rates compared favorably to historical programmatic outcomes and track early implementation experiences elsewhere.

Reported adverse events mirrored known patterns for these regimens. However, adverse-event reporting was incomplete, prompting the authors to call for strengthening pharmacovigilance systems and routine data capture to match the pace of clinical rollout.

PeerLINC supported Nigeria’s scale-up by closing a critical training gap. An international technical assistance provider, with USAID funding, had conducted operations research for BPaL from 2021–2023 but did not provide nationwide training or capacity building, leaving many sites unfamiliar with implementing BPaL/M despite medicines already procured.

Following discussions with TB Alliance in March 2024, PeerLINC organized practical training for 63 physicians and laboratory specialists in Abuja in July 2024. With co-funding mobilized by TB Alliance, the PeerLINC program delivered responsive, cost-efficient technical assistance support.

Nigeria is now actively scaling up BPaL/M with ongoing efforts to ensure widespread adoption and effective treatment outcomes. Continued investments in lab monitoring capacity, standardized adverse-event reporting tools, and timely feedback loops from facilities to the national TB program will further strengthen the country’s DR-TB response.

Photo credit: Muhammad-Taha Ibrahim