Sandoz is the generic drug subsidiary of Novartis, a multinational pharmaceutical company. The company develops, manufactures and markets generic drugs as well as pharmaceutical and biotechnological active ingredients. Mr Mohit Malhotra, managing director of Sandoz India gives insights on Sandoz's TB-related initiatives.

What led your organization to focus on tuberculosis?
Sandoz is committed to create a healthier world in which everyone has access to affordable high-quality medicines. Despite the fact that approximately 95 percent of the basic drugs included in the WHO Essential Drugs List are patent-free and therefore cost-effective, many are still unavailable locally in several countries in the southern hemisphere.

Approximately two million people die from tuberculosis every year - that is approximately one person every 15 seconds. Sandoz, a subsidiary of the Novartis Group, has a long history of helping tuberculosis patients. In 1960s, Novartis predecessor firm Ciba-Geigy, spearheaded the development of rifampicin, which remains as the cornerstone of modern TB treatment today. Sandoz today provides fixed dose combinations (FDCs) of the four leading first-line drugs (including rifampicin), which conform with all WHO guidelines.

What are the achievements of Sandoz on the TB front?
In addition to the discovery of rifampicin, Sandoz has made significant developments in drug delivery, greatly improving patient compliance through less complex dosing regimens. In the late 1990s, Sandoz developed the WHO-recommended gold standard fixed-dose combination (FDC) therapy - containing rifampicin, isoniazid, pyrazinamide and ethambutol - which delivers four medicines in a single pill. Such drug delivery advancements are critical as life-threatening TB bacterial resistance is a growing challenge not only in Asia but also in European countries.

Effective TB treatment is strongly dependent on patient compliance and adherence with the Directly Observed Treatment Short-Course (DOTS) method recommended by the WHO. Barriers to the successful treatment often include poor infrastructure and lack of understanding. As an example, a Patient-Centered Treatment (PCT) approach was launched in Tanzania in collaboration with our parent company Novartis and the Ministry of Health, which builds on the DOTS method and offers patients greater flexibility in choosing their place of treatment, i.e. at the health facility or at home supervised by a family member. This project (PCT) has had a positive effect on adherence throughout the full course of treatment as well as on outcomes and cure rates for patients.