Treatment of multidrug-resistant tuberculosis (MDR-TB) with modified shorter all-oral treatment regimen (mSTR) under operational research conditions in Belarus

<b>Background:</b> New and repurposed TB drugs and shorter regimens can radically change the landscape for treating MDR-TB. In December 2019, the WHO issued “Rapid Communication” related to MDR-TB management; WHO reiterated their earlier recommendation that a majority of MDR-TB patients are to receive all-oral treatment regimens, and now allows for shorter duration regimens to be considered under special conditions. <b>Methods:</b> In October 2018 Belarus started to use mSTR for MDR-TB under operational research conditions which include: study protocol; ethics committee review; treatment delivery under WHO-recommended standards. Thirty-nine-week regimen with Lvx, Bdq, Lnz, Cfz and Cs was selected. To be included patients should have laboratory confirmed TB with initial resistance to at least R. Exclusion criteria are: resistance to or previous treatment with any drug of the regimen; QTcF interval longer than 500 msec; ALT/AST more than 5 times higher than upper limits. <b>Results:</b> By 1st February 2020, the programme has included 300 patients. Of them 73 had final treatment outcomes: the median age was 45 years; 79% males; with co-morbidity: HIV - 5%, HCV - 7, DM - 4, Harmful use of alcohol - 15%. The following final treatment outcomes were recorded: treatment success: 67 (91%); lost to follow up: 2 (3%); death: 4 (6%). All deaths were not due to TB or medication. The adverse events were mild and did not prompt the treatment to be stopped. <b>Conclusions:</b> The use of mSTR for MDR-TB under operational research conditions in Belarus shows promising results. The experience gained can promote further expansion of mSTR use to programmatic level.