Nigeria is the first country in West Africa to provide people with tuberculosis (TB) access to the groundbreaking new BPaL treatment under operational research conditions. This six-month, three-drug,  oral treatment is meant for people with advanced forms of drug resistant TB and is expected to have a higher success rate than previous treatments with 4-6 medicines which lasted at least 18 months.

The BPaL regimen (consisting of the drugs pretomanid, bedaquiline and linezolid) was developed by TB Alliance and is implemented in Nigeria by the National TB Program (NTP), with support from KNCV Tuberculosis Foundation (KNCV).

“We are excited about this novel treatment option which will hopefully presents much relief to our patients. Winning the battle against tuberculosis remains our mission as KNCV” Dr. Falokun Victor, KNCV Project Manager, BPaL Nigeria

The BPaL regimen has been approved by the U.S Food and Drug Administration (FDA), the European Medicines Agency (EMA), the Drug Controller General of India and recommended by the WHO under operational research conditions.

“The BPaL operational research is an intervention coming in at the right time to alleviate the suffering experienced by patients managed using the individualized regimen of 18 months with 4-6 different medicines. This will go a long way to provide quality treatment care and support for DR-TB patients across the country” Dr Babawale Victor TB specialist and research coordinator (NTBLCP).

New hope for people with drug resistant TB

Nigeria is ranked seventh out of the 30 highest burden countries for tuberculosis and second in Africa. In the year 2019, an estimated 440,000 new cases occurred (of these, 46,000 were also HIV-positive) and about 150,000 Nigerians died from tuberculosis (TB) according to WHO.

TB accounts for more than 10% of all deaths in Nigeria. Every hour, nearly 30 people die from the disease, despite effective treatments being available.

Most people can be cured of TB with a standard, inexpensive treatment. However, for people with advanced resistance conventional drugs do not work. Treatment is much longer (18 months) and less effective. According to the WHO, the cure rate of these forms of resistant TB worldwide is only 57 percent as of 2020. However the new BPaL regimen (6 months, all oral) has shown a cure rate of 90 percent in  this patient group, according to Phase 3 trial results published in the New England Journal of Medicine.

BPaL roll-out and scale-up

The official roll-out in Nigeria started second week of April in Bauchi state with three other states namely, Lagos, Adamawa and Kano to follow.


Ruth Iliya, who was first diagnosed in January 2021 is the first TB patient in Nigeria to be treated with the new, ground-breaking TB treatment: the BPaL regimen. This treatment for people with advanced forms of drug-resistant tuberculosis is much shorter than previous treatments and consists of only 3 oral drugs. Above all, BPaL is expected to have a much higher success rate. This brings new hope to patients with this form of TB.

Ruth with the KNCV team, NTBLCP team and her Doctors at ATBUTH DR-TB Treatment Center during the BPaL enrollment

Ruth and her family reside in Abuja, where she was first diagnosed.

I was referred to Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH) from FCT TBLCP in Abuja where I had been on other treatment drugs but the weakness and coughing continued,” she says.

The doctor at ATBUTH Bauchi diagnosed  a serious form of resistant TB and Ruth was admitted immediately. Prior to her been diagnosed, Ruth planned to write the West African Examinations Council (WAEC) in Bauchi. This examination is a graduation certificate awarded to most students in Nigeria. This she will do while living with her uncle in Bauchi since her parents will not be able to stay with her all through the exam period in another state due to their jobs; unfortunately, she became ill. Her uncle is presently her guardian in Bauchi while she is receiving treatment.

I can’t wait to get better and return to school. I do not want to miss my graduation examination” Ruth says.

But at the same time, she is hopeful.

Administration of the BPaL drug by Dr. Jacob Dunga, Internal Medicine Specialist and Research Clinician at ATBUTH

I feel so much better after starting the drugs last week, I am regaining my strength day by day”.

The 17-year-old High school student is now enrolled on BPaL and grateful that she has access to this new treatment.