WHO announces forthcoming changes for the programmatic management of TB preventive treatment
27 February 2020 | GENEVA In a Rapid Communication issued today, the World Health Organization (WHO) is announcing a number of updates to its latest guidance on tuberculosis (TB) preventive treatment. These changes are expected to enhance the scale-up of preventive treatment worldwide in line with the vision of the WHO End TB Strategy and the UN High-Level Meeting in 2018. The release of this Rapid Communication at this juncture is important to inform countries as many of them are in the process of developing national TB strategic plans and related funding proposals for donors like the Global Fund.
An estimated one-fourth of the world’s population is infected with the TB bacterium, of whom about 5-10% advance to active TB disease in their lifetime. TB preventive treatment, when given to people at the highest risk of progressing from TB infection to disease, remains a critical intervention to benefit individuals and communities alike. Globally, preventive treatment of people at risk, particularly contacts of TB patients, remains low. Unless this is stepped up rapidly, the global target of reaching at least 30 million people with TB preventive treatment by 2022 will not be reached.
“TB preventive treatment is an important cornerstone of the End TB Strategy. Ensuring that everyone can obtain the treatment they need, to prevent TB infection from developing into active TB disease, will save lives and reduce suffering.” said Dr Tereza Kasaeva, Director of the WHO Global TB Programme. “Along with the new guidelines, WHO will release other tools to strengthen uptake and implementation of the latest recommendations. We request continued commitment and stakeholder support to rapidly scale up access to preventive treatment for the millions in need.”
Main updates
The key updates of the 2020 guidelines will feature the following:
- The GDG for the 2020 guidelines broadened the applicability of five of the previous recommendations across all burden settings while highlighting the implications of implementation in areas with low and high TB incidence. In this context the importance of appropriate resource mobilization is stressed.
- A regimen of one month of daily rifapentine plus isoniazid (“1HP”) and another regimen of four months of daily rifampicin (“4R”) are now proposed as TPT options for both high- and low- TB incidence settings.
- Based upon the latest study results the GDG considered that a systematic deferral of isoniazid preventive treatment (IPT) to the postpartum period in pregnant women living with HIV would deprive them of significant protection when they are highly vulnerable to TB. While acknowledging a need for more research, pregnancy does not disqualify women living with HIV from receiving preventive treatment with the TB medicines isoniazid and rifampicin.
- There are no grounds to support dose changes when rifapentine and dolutegravir are used together (however the dose of dolutegravir needs to be increased when it is given with rifampicin).
- Overall, the guidelines document has also been extensively revised, with a reorganization of the content of the different sections; additional commentary accompanying the recommendations; an updating of references to the most recent citations and evidence; aligning the durations of certain regimens to the ones most often used; and merging the four previous algorithms into one. The research gaps have also been updated to reflect the latest status of the evidence.
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