Short and powerful treatment regimen is redefining tuberculosis care in Somalia

“During the first four months, I couldn’t get out of bed and felt like a lifeless body,” says Ahmed Elmi Mohamud, a 65-year-old former schoolteacher from Garowe, in northeastern Somalia. “But now, I feel much better.” 

He shares his journey of overcoming tuberculosis after receiving treatment at Mudug tuberculosis hospital in Galkayo, where Médecins Sans Frontières (MSF) teams support with treating drug-resistant tuberculosis. 

“I took every single dose of the medication as prescribed, without missing any, because I knew how important it was for me. I felt like each pill was a step closer to getting my life back,” he says. “After six months of taking the prescribed tablets, I finally won the fight against tuberculosis.” 

“The medication left me with some side effects, but more importantly, it helped me overcome a disease that once made me fear for my life,” says Ahmed.
 

Recurrent conflicts and drought - among other climatic hazards - in the northeast region have led to displacement, forcing many families to live in overcrowded conditions. People also contend with a weak healthcare system and food insecurity, leading to poor nutrition. These are all exacerbating factors that further the risk of catching an infectious disease like tuberculosis, or drug-resistant tuberculosis, within households and communities. But now, a shorter and simpler treatment option for drug-resistant tuberculosis is changing patients' lives and providing a new hopeful outlook for tuberculosis treatment in Somalia

Somalia is among the 30 countries with the highest multidrug-resistant tuberculosis burden globally. Tuberculosis patients in Somalia often face numerous barriers to accessing timely diagnosis and appropriate treatment, which significantly contributes to worse health outcomes and the development of drug-resistant tuberculosis. 

“I am a casual worker but when I tested positive for tuberculosis, I could not go to work anymore,” says Abdi Mohamed, currently in treatment at the tuberculosis hospital. “Honestly, you can imagine the pain of not being able to provide for [your] family, watching them struggle while you feel helpless. I was very worried because I thought I had a deadly disease that indeed made me fear for my life. But it turned out differently. I feel healthy after taking the medication.” 

A new treatment regimen is making it easier for patients like Abdi Mohamed to complete their full course of medications.
“The BPaLM treatment regimen, which gets its name from being composed of the drugs bedaquiline, pretomanid, linezolid, and moxifloxacin, has reduced both the duration of treatment and the number of tablets a patient has to take,” says Dr Ahmed Hassan, a medical doctor who has worked for 18 years at the tuberculosis hospital. “Now, the treatment lasts only six months, and patients take just six or seven tablets daily. This has greatly improved treatment compliance and reduced many of the adverse effects patients used to experience, such as leg pain and body aches.” 

The availability of this new treatment regimen is especially vital in conflict-prone countries like Somalia, where limited access to healthcare makes effective treatment more difficult.

Most patients receiving treatment at the tuberculosis hospital come from villages and towns surrounding Galkayo. Unable to work because of tuberculosis, many people struggle to afford the travel to and from Galkayo. Accommodation is also a challenge as some patients have no family members to host them in town, making it even more difficult to adhere to their prescribed medication.

“The biggest challenge is that many of these patients do not live in this town,” says Dr Hassan. “They come from distant areas, and the treatment lasts for many months. They do not have access to shelter and food. This centre operates as an outpatient facility.” 
“We serve those within the town daily or weekly,” he says. “For those who live outside the town, we provide them with a month's supply of medication. That is how we manage it.”
 

Patients struggle between the need to provide for their families and the need manage their own health- all while having to pay for travel to Galkayo, whether from near or far away. People with limited income and resources have to make difficult decisions to prioritise their health. As a result, many are unable to access consistent treatment.

MSF teams manage the treatment of drug-resistant tuberculosis at Mudug tuberculosis hospital, in collaboration with the Ministry of Health and the national tuberculosis programme. This year, of the ten patients currently receiving the BPaLM treatment regimen, two have successfully completed it, with promising outcomes that underscore the regimen's effectiveness.

The BPaLM regimen is showing impressive results, offering hope to patients in Somalia. With fewer side effects and a shorter treatment period, this approach has the potential to transform tuberculosis care in the country. In regions where healthcare access is limited due to ongoing conflict and drought, scaling up the use of this regimen could greatly improve patient outcomes.

By focusing on accessible and efficient care, MSF's efforts to roll out the BPaLM regimen demonstrate our commitment to tackling drug-resistant tuberculosis, particularly in areas where consistent treatment remains a challenge.

To ensure wider access, there is an urgent need to decentralise tuberculosis care in Somalia. By bringing treatment closer to remote and underserved communities, it will be easier for patients to access the care they need, improving their adherence and reducing the burden of long journeys to hospitals. Decentralising tuberculosis care, alongside scaling up the BPaLM regimen, is crucial for reaching more patients and making lasting progress in the fight against drug-resistant tuberculosis.