India recently entered a new stage in its fight against multi-drug resistant tuberculosis (MDR-TB) by initiating the STREAM Stage 2 study at two sites.  The first STREAM patient in India was screened on December 18, 2017 at BJ Medical College (BJMC) and Civil Hospital in Ahmedabad.  

 STREAM Trial investigators at their site initiation training at NIRT in September 2017
STREAM Trial investigators at their site initiation training at NIRT in September 2017

The STREAM trial is evaluating new treatment regimens for MDR-TB patients, which could provide solutions for a country like India with a very high burden of MDR-TB. India is the first country from the World Health Organization’s South East Asia region to join the trial.

India has come on board with two sites – The National Institute for Research in Tuberculosis (NIRT) in Chennai and BJMC.  This is an important milestone in the history of the STREAM Trial.

NIRT, known for the historic “Madras Study”, is an institute under the Indian Council for Medical Research (ICMR) dedicated to TB research for the last 5 decades and enjoys WHO Supranational Reference Laboratory status for the South East Asia Region.

BJ Medical College and Civil Hospital was the first site to roll out MDR-TB services in India in 2007.  It is also designated as  a centre of excellence in training on MDR-TB management.

Over the last five years, India has made significant gains in strengthening the programme architecture and implementation environment for TB control with several initiatives pertinent to the management of drug-resistant TB.  These include scale-up and expansion of programmatic management of drug resistant TB services to achieve country-wide coverage, launch of a Revised Technical and Operational Guidelines detailing regimen build-up for early treatment stratification guided by drug sensitivity testing results, and the roll-out of a Bedaquiline Conditional Access Programme to enhance access to newer drugs.

On India starting to enrol patients in STREAM Stage 2, Dr Soumya Swaminathan, the recently appointed Deputy Director General of WHO, who previously held the posts of Director General, ICMR and Secretary, Department of Health Research (2015-2017) and Director NIRT (2012-2015), commented: “This is an important milestone for India and the trial.  We are pleased to be participating in the trial and contributing to the much-needed development of shorter, more effective and tolerable regimens for MDR-TB.”