Editor’s Note: This blog was originally published in Spanish on Socios En Salud’s blog.
Elvis Espinosa is fascinated by music. Above all, he loves the huaynos genre of his native La Oroya, a mining town nestled at an altitude of more than 3,000 meters in the department of Junín.
Two decades ago, he migrated to his current home in the Carabayllo district, north of Lima, where he keeps an alto saxophone. He often sits next to his eldest son—now 16—and plays a few notes, more for the intimate pleasure of remembering than for the precision of the melody.
But, just four years ago, holding that saxophone seemed like an impossible, almost unthinkable task.
In 2021, Espinosa was told he’d recovered from COVID-19, although he was experiencing persistent symptoms that worried him.
“I kept coughing harder, I started spitting blood, and then I went to a medical center,” he recalls. The diagnosis came as a blow: tuberculosis.
Unfortunately for Espinosa, treatment wasn’t going to be simple. The clinicians explained to him that he was facing a variant that was resistant to first-line medications, known as multidrug-resistant tuberculosis (MDR-TB).
Treatment for this form of TB consisted of a routine of up to 16 pills a day accompanied by painful injections that, despite their severity, provided no relief. Week after week, his body shrank: from his usual weight of 183 pounds, he dropped to just 95.
Although the physical toll was undeniable, Espinosa says the feeling of worthlessness was what weighed him down the most. Before his diagnosis, Espinosa had acquired a new piece of land where he dreamed of building a house. After becoming sick, he was unable to work, without income to support his wife and two children. The land that was once a dream transformed into a mountain of unpayable debt, and depression began to dominate his life.
“I was like that for a year. I thought I was getting better, but four, five, six months would go by, and nothing,” he said. “I kept bleeding, there was no recovery.”
In December of that year, he traveled with his family to La Oroya, believing this would be his last return to his birthplace. His disease had progressed to an even more complex form, pre-extensively drug-resistant TB (pre-XDR TB), resistant to several additional medications and much more difficult to treat.
There seemed to be no hope for improvement. Until a clinical trial, implemented in Peru by Socios En Salud, as Partners In Health is known locally, literally came knocking.
From the Lab to the Neighborhood: How endTB-Q was Born
In clinical terms, pre-XDR TB is defined as rifampicin-resistant (RR) or multidrug-resistant (MDR) tuberculosis, which also presents resistance to fluoroquinolones, or broad-spectrum antibiotics. This makes pre-XDR TB a more complex form to treat than RR/MDR-TB, which still offers better cure rates.
“This combination offered fewer treatment options,” said Dr. Jimena Ruiz, coordinator of the Clinical Trials Unit at Socios En Salud. “Previously, it was thought that resistance only appeared due to treatment noncompliance, but today we know that someone can be directly infected with a resistant form.”
In 2023, the World Health Organization (WHO) estimated 10 million new cases of TB, of which nearly 100,000 were pre-XDR. In Peru, that same year, 1,424 cases of MDR-TB were recorded. Among these, the pre-XDR fraction is smaller, but especially critical, requiring treatment of up to 18 months with potent drugs and constant monitoring.
To address this burden, the endTB project, a partnership between PIH, Médecins Sans Frontières, and Interactive Research and Development, and funded by Unitaid, has been working to develop less toxic and faster therapies against drug resistant forms of TB. As part of this partnership, the endTB-Q clinical trial was specifically designed to address pre-XDR TB.
The study recruited 324 participants from six countries, 6% of which were in Peru, to begin during the COVID-19 pandemic.
“The experience was intense. Patients arrived in very serious condition, and we had to monitor them for two years in a context of fear and uncertainty,” Dr. Ruiz said. “When we started, the treatments were long, with injectables and hospitalizations. Today, we talk about shorter, all-oral regimens.”
Responding Amid a Pandemic
At the height of Espinosa’s illness, Socios En Salud found him at a local health clinic, reviewed his TB records, and invited him to participate in the endTB-Q study.
“They told me they would support me with the medications, that they would bring them to my home, that I would no longer have to go to the health center or spend money on travel,” Espinosa shared. “Socios En Salud gave me transportation to appointments and support vouchers. The treatment lasted a year, but it was all pills, no injections.”
The support, however, went beyond his immediate clinical needs. Amidst debt and the depression exacerbated by the disease, Espinosa received also psychological and social support. For Dr. Ruiz, this support makes a unique difference.
“It’s something that sets Socios En Salud apart: we apply the same comprehensive support approach in clinical trials as in our community programs,” Dr. Ruiz said.
Espinosa began to feel his body recovering. Unlike the treatment he had received early in his TB journey, he now took only four pills a day, had monthly checkups, and felt his recovery—improving and gaining weight each month.
Groundbreaking Results
In November 2024, Socios En Salud’s Clinical Trials Unit traveled to Bali, Indonesia, for the Union World Conference on Lung Health, where preliminary results of the endTB-Q trial were presented. In July 2025, the full findings were published in The Lancet.
The study ultimately found that people who received an experimental six- to nine-month regimen of four key drugs—bedaquiline, delamanid, linezolid, and clofazimine—achieved a cure rate of 87%, and up to 93% in those who started with limited disease.
Compared to standard treatment of up to 18 months with injectables and severe adverse effects, this new regimen opens a shorter, safer, and more tolerable path for those facing the most resistant form of tuberculosis.
However, the study revealed that not all cases were straightforward. In people with very advanced tuberculosis, nine months weren’t enough to prevent relapses. But Dr. Ruiz emphasized that, “it’s key to vigorously support treatment, carefully manage side effects, and maintain people’s trust.”
For Espinosa, the endTB-Q trial allowed him to recover his life: the lost weight, his ability to work, his spirits, and his saxophone.
In the living room of his home in Carabayllo, the saxophone remains untouched. Espinosa glances at it from time to time but hasn’t yet picked it up to play. He doesn’t need to touch it to know that, after his TB treatment, he will have recovered enough breath to try making music again.
