More investment and greater collective efforts needed now if global TB preventive treatment targets are to be met

Putting in place proven measures to prevent tuberculosis (TB) infection from becoming active disease must rapidly become a much higher priority for high burden countries if the commitments made at the 2018 United Nations High Level Meeting (UN HLM) on TB are to be honoured.

The current COVID-19 emergency presents an additional challenge for TB programmes worldwide. Nonetheless, this should not stop national TB programmes from planning and launching a systematic and invigorated drive to boost contact investigation, TB Preventive Treatment (TPT) and treatment for TB.

The World Health Organisation, in partnership with The Union, KNCV Tuberculosis Foundation, International AIDS Society, USAID, UNICEF, UNITAID, the Stop TB Partnership, European Respiratory Society and The Global Fund, is calling upon governments and national TB programmes to act now to ensure the 30 million people identified as being at risk of developing active TB disease receive TPT by 2022.

Dr Grania Brigden, Director of the Department of Tuberculosis for The Union, said: "We must ramp up efforts to prevent TB if we have any hopes of ending the TB epidemic. We must expand our focus from solely curing TB to also focus on preventing illness in the first place – and thus foregoing difficult treatments, long-term side effects and illness. We have the tools and we know they work. We now need the commitment, the investment and the action on a country by country basis to make this happen.

"The value of TPT to the lives of millions of individuals, their communities, and their governments, cannot be disputed. And as we expect that people with TB will have worse outcomes with COVID-19, there is an added imperative to prevent TB. The initial investment required to build and scale up TPT programmes will be more than covered by savings in reduced demand on healthcare thanks to healthier, happier more productive people."

In 2018, countries reported achieving TPT coverage in 1.8 million people living with (PLHIV), in about 350,000 children aged five years old and under, and, in a further 79,000 people in high-risk categories, according to WHO Global TB report 2019.

At the current rate of recruitment, only the UN HLM target of TPT being provided for six million PLHIV by 2022 should be reached. However, the commitment to provide TPT for a further 24 million household contacts of people with TB of all ages looks likely to be missed by a huge margin, unless drastic action is taken now.

To overcome the main barriers standing in the way of global scale-up in TPT, Overcoming Key Barriers To Scale Up Tuberculosis Preventive Treatment: A Call to Action lays out a series of solutions that countries, partners, donors and communities should work together to overcome:

  • ensure that all TB programmes aiming to end or eliminate TB include TPT as an integral part of a comprehensive strategy
  • advocate strongly and communicate widely for TPT scale-up
  • strengthen contact investigation in the community and in households of people with active TB especially in the current context of the COVID-19 pandemic
  • initiate contacts of all ages on TPT after TB disease is ruled out
  • expand TPT in HIV services and in facilities caring for other people eligible for TPT
  • develop capacity to test for TB infection and to exclude TB disease
  • provide better tolerated and shorter TPT options on a large scale
  • ensure adherence and completion of the full course of TPT
  • collect data on contact investigation, and the initiation and completion of TPT to monitor programme performance.

Make sure you visit The Union’s free open access online course Prevent Tuberculosis: Management of TB Infection

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