Paper highlights new innovations and strategies in TB prevention for people living with HIV

The paper, titled ‘New opportunities in tuberculosis prevention: implications for people living with HIV’ and published in The Journal of the International AIDS Society, calls for tuberculosis (TB) preventive treatment to be integrated into a standard package of care for people living with HIV (PLHIV), using new tools and strategies. Several TB prevention regimens, which are safe, effective and can be used with current antiretroviral therapy (ART) are now available. Through robust collaboration between HIV and TB programmes, TB, a preventable and curable disease, should cease to be the leading cause of death among PLHIV.

“We have the evidence and new tools for HIV programmes to ensure that all PLHIV who are at risk of TB can benefit from preventive treatment. By ensuring that all PLHIV eligible for TB preventive treatment receive it and are supported through treatment will not only save lives but also contribute to global TB elimination efforts”, said Dr Grania Bridgen, Director of The Union’s Department of TB and co-author of the paper. “TB preventive therapy in PLHIV should be part of a comprehensive approach to reduce TB transmission, TB disease and deaths from TB. It is an urgent priority globally.”

In order to achieve global targets to end the TB epidemic, preventive treatment of persons at high risk of TB, including PLHIV is essential. In 2018, the United Nations (UN) High-Level Meeting (HLM) on the fight against TB committed world leaders to provide TB preventive therapy to at least 30 million people, including six million PLHIV. By the end of 2018, only 640,000 persons newly enrolled in HIV care had been started on TB prevention.

Despite TB being the leading cause of death in PLHIV and evidence showing that TB prevention is cost effective, reduces TB incidence and mortality in PLHIV, and WHO recommendations regarding the importance of TB preventive treatment in PLHIV, scale‐up within HIV programmes has been slow.

The paper proposes that effective programmatic scale‐up can be achieved by combining new regimens with context-adapted, people‐centred models of care, such as differentiated service delivery models that vary the location of the service or the frequency of interaction with people getting treatment, and distribute tasks among health-care staff and peers. Hence, integrated care models that incorporate TB screening and provision of preventive treatment can be provided without increasing the frequency of clinic visits. In addition, tailoring support assures better adherence to treatment.

The paper demonstrates that robust collaboration between HIV and TB programmes and focussed engagement with communities, including TB active case‐finding and the prompt initiation of anti‐TB therapy among PLHIV, can combine to decrease morbidity and mortality from TB in PLHIV.  

Last month, a Union review paper highlighted the critical action points for the treatment of people with TB infection more broadly, considering who should be targeted and the best means of treating them.