WHO consolidated guidelines on tuberculosis: module 1: prevention: tuberculosis preventive treatment

Overview

Background

About one fourth of the world’s population is estimated to be infected with the tuberculosis (TB) bacterium, and about 5–10% of those infected develop active TB disease in their lifetime. The risk for active TB disease after infection depends on several factors, the most important being the person’s immunological status. TB preventive treatment given to people at highest risk of progressing from TB infection to disease remains a critical activity to achieve the global targets of the End TB Strategy, as reiterated by the UN High Level Meeting on TB in 2018. Delivering treatment effectively and safely necessitates a programmatic approach to implement a comprehensive package of interventions: identifying individuals at highest risk, testing for infection, excluding active TB, choosing the treatment option that is best suited to an individual, managing adverse events, supporting medication adherence and monitoring programmatic performance.

The 2020 recommendations for the programmatic management of TB preventive treatment are the first to be released under the rubric of WHO consolidated TB guidelines (Module 1 – Prevention). The WHO consolidated TB guidelines will gradually group all TB recommendations and will be complemented by matching modules of a consolidated operational handbook. [1] The handbook will provide practical advice on how to put in place the recommendations at the scale needed to achieve national and global impact. The first handbook module in the series will be on the programmatic management of TB preventive treatment and will accompany the 2020 guidelines.

Overview

The 18 recommendations on tuberculosis preventive treatment in the 2020 update cover critical steps in programmatic management that follow the cascade of preventive care. The main changes introduced include conditional recommendations for a 1-month daily rifapentine and isoniazid regimen and a 4-month daily rifampicin regimen as alternative treatment options in all TB burden settings. Advice on isoniazid preventive treatment in pregnancy and on the concomitant use of rifapentine and dolutegravir has been updated to reflect the findings from latest studies. The operational limitations that need to be overcome by countries to achieve global targets are highlighted and will be discussed in greater detail in the accompanying operational handbook that is being released concurrently. The guidelines are to be used primarily in national TB and HIV programmes, or their equivalents in ministries of health, and for other policy-makers working on TB and HIV and infectious diseases in public and private sectors and in the community.