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My patient’s choice – the Jolene Samuels MDR-TB Pledge

A carer’s pledge to offer patients an informed choice between a novel drug or an injectable drug for the treatment of MDR-TB

~ In loving memory of nurse Jolene Samuels, MDR-TB Champion & Cochlear Implant recipient ~

Jolene Samuels #TBunmasked from Visual Epidemiology on Vimeo.


I, the undersigned, am involved in the direct and/or indirect care of people with MDR-TB (multidrug-resistant tuberculosis). I hereby pledge to empower the people I care for to choose between the use of a novel drug (currently bedaquiline or delamanid) or an injectable aminoglycoside drug as part of their MDR-TB regimen, based on all relevant information about known benefits and risks shared with them.

I acknowledge that there are current data limitations, but in my opinion there is enough information to reasonably assume that MDR-TB regimens with a novel drug are at least equally effective compared to the old MDR-TB regimen containing an injectable during the intensive phase of treatment. Based on all available information, as summarised in a recent review by Reuter et al, both current novel drugs likely result in fewer serious adverse events than the injectables, particularly debilitating irreversible ones such as hearing loss, which may occur in as many as half of people treated with injectables for MDR-TB. I am also aware that an individual patient data meta-analysis of 9153 patients from 32 observational studies with MDR-TB in 2012 by Ahuja et al found no association between the use of any injectable agent and the probability of treatment success. Furthermore, in the new shorter MDR-TB treatment course of nine months the injectable agent has been replaced by bedaquiline for all pregnant patients in the Western Cape Province of South Africa, and injectable-free regimens have been recommended by the WHO for some children who are living with MDR-TB.

There are a number of clinical trials currently being done to formally assess the efficacy and safety of injectable free regimens, but the results of these studies are likely to take several years to become available. Given the limited evidence to support the efficacy of injectable agents and the clearly documented safety risks they pose, I believe that persons living with MDR-TB should be offered treatment options that would allow them to avoid the use of injectable agents in their treatment plan, while simultaneously according them the right to enjoy the benefits of scientific progress. (London et al, 2016)

I therefore commit to giving every person diagnosed with MDR-TB under my care the opportunity to choose whether they would prefer to be treated with an MDR-TB regimen that contains a novel agent (either bedaquiline or delamanid) or one that contains an injectable agent. In settings where novel drugs are not yet available, I will ensure my patients can take part in shared decision making about their care and I will support their calls for access to safer and more effective alternatives.



Anybody involved in the direct or indirect care of people with TB is most welcome to sign on. For more information or if you would like to get more involved, please email

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Dr. Sheetal Sharma  
Pritesh Shah  
Pritesh Shah  
Abbas Ismail  
Pavani Reddy Yarram  
Dukhan Singh Munda  
Sandip Ghayal  
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Pat Bond  
Nirupa Misra  
Iqbal Master  
Lindelwa Cindi  
Rodolfo Romero  
Ebrahim Variava  
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Zangmo’ Kinley  
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Arlette Bekker  
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Hameline Chimuka  
Busi Msimang  
Sibongile Tshabalala  
Nicolien Wydeman  
Christel van Zyl  
Felicity Raw  
Tariro Kutadza  
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Thato Mosidi  
Goodman Makanda  
Neesha Haridus  
Mike Roy  
Norbert Ndjeka  
Rue Rushwaya  
Nkateko Mkhondo  
Gavin Churchyard  
Barnabas Yisa  
Karin Turner  
Gabriella Ferlazzo  
Anele Yawa  
Noma Rangana  
Salome Charalombous  
Leigh Berrie  
Glenda Muzenda  
Pren Naidoo  
Lauren Jankelowitz  
Francois Venter  
Ndaw Bechir  
Dipela Mondi  
Esther Sonamzi  
Wieda Human  
MARIA ALICE DA Silva tellesTelles  
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Ashton Joseph  
Liana Horn  
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Colette Gunst  
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Maritsa Kotze  
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Mavo August  
Noluvo Ngambu  
Lydia Lewis  
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Thami Mthebe  
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Nontle Plaatjie  
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Dadu A drei  
Nishant Chavan  
Maria Elena Binlayan  
miriam arago galindo  
Javier Pablo Ansmaria Cardenas  
Carly Rodriguez  
Marianna Theron  
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Oxana Domenti  
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melanie lambrechts  
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tali cassidy  
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Faudia Forster  
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Kristal Duncan  
Rodd Gerstenhaber  
Erika Mohr  
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Kolawole Ekanoye  
Kolawole Ekanoye  
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Raghavendra Patil  
Dr Rahul Thakur  
Haydee Rumaldo  
Chenise Naicker  
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Ana Millones  
Esther Sonamzi  
Esther Sonamzi  
Ruvandhi Nathavitharana  
Helene-Mari van der Westhuizen  
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Rafael Laniado-Laborín  
Wubshet Jote Tolossa  
Milagros Mendoza  
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Maria Stuttaford  
edwardo patac  
Shrikant Peters  
Mo Barry  
Raghavendra Patil  
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Vanessa Carrillo Montenegro  
Colleen Daniels  
Kagiso Norman Matiting  
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Andrew Rosser  
Daisy Dharmaraj  
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Dirk von Delft  
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Delene Martin  
Faieka Samsodien  
Judy Caldwell  
Thato Mosidi  
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wanjiru Naomi  
Pam Britt  
Rosa Herrera  
Lynn Gardner  
Teresa Wilson  
Ananja Van der Westhuizen  
Koot Kotze TB Proof Kotze  
Bart Willems  
Fraser Wares  
Marion Heap  
Zara Trafford  
Mogie Reddy  
James Seddon  
Rutanga Claude Rutanga Claude  
Abeda Williams  
Marcela Tommasi  
Bonnie Snyders  
Lucica Ditiu  
Angela Dramowski  
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Norah Pezisa  
Virginia Zweigenthal  
Margaret Matthews  
Jeanette Lochner  
Karin Huyssen  
Adelaide Kekana  
Nandipa Mafongosi  
Eveline Klinkenberg  
Max Meis  
André Van Zyl  
Amber Kelly  
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    Civil Society/NPO/NGO
Jurgens Peters  
Sir Professor Alimuddin Zumla  
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Mandy Slutsker  
Wubshet Jote Tolossa  
Mary Miller  
Warick Van Der Lingen  
Zolelwa Sifumba  
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Andrea Von Delft  
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Wieda Human  
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Michelle Galloway  
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Arne von Delft  
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Arne von Delft  
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