World TB Day: WHO urges TB prevention scale-up in new recommendations

Tedros Adhanom Ghebreyesus

WHO has issued updated guidance meant to decrease the development and transmission of tuberculosis in conjunction with World TB Day, which is observed every year on March 24.

According to WHO, a quarter of the world’s population is estimated to be infected with TB bacteria. While these individuals are neither sick with TB nor contagious, they are at greater risk for developing TB disease, the world’s top infectious killer. In 2018, 10 million people were diagnosed with TB worldwide and 1.5 million people died from it.

“The world committed to end TB by 2030. Improving prevention is key to making this happen,” WHO Director-General Tedros Adhanom Ghebreyesus, PhD, MSc, said in a release. “Millions of people need to be able to take TB preventive treatment to stop the onset of disease, avert suffering and save lives.”

Some progress has been made in meeting the goals for ending TB that were established at the UN Meeting on TB in 2018, but TB preventive treatment has been “largely neglected,” according to WHO. One such neglected target is guaranteeing access to preventive treatment by 2022 for at least 24 million contacts of people with active TB and 6 million people with HIV. According to WHO, to date, “only a fraction” of the target has been met. Countries provided TB preventive treatment to less than 430,000 contacts and 1.8 million people living with HIV in 2018.

WHO officials said that reinvigorated efforts are necessary to improve access to preventive treatment, a position that led to the new WHO guidelines.

In the new guidelines, WHO suggested a scale-up of preventive treatment for those at highest risk, including household contacts of patients with TB, people living with HIV and other people at risk, including those with lowered immunity or individuals living in crowded settings. The guidelines suggest that TB preventive treatment services are integrated into ongoing case-finding efforts for active TB. Such efforts include recommendations for screening all household contacts of patients with TB and people living with HIV for active disease. Per the guidelines, once active TB is ruled out, these populations should be started on preventive treatment.

The updated guidelines also recommended the use of either a tuberculin skin test or an interferon-gamma release assay in testing for TB infection. According to WHO, both are useful for finding people more likely to benefit from TB preventive treatment, but should not become a barrier to increasing access.

Lastly, the updated WHO recommendations suggest new, shorter options for preventive treatment in addition to the broadly used regimen of 6 months of daily isoniazid. Options for shorter treatment include a 1-month daily regimen of rifapentine plus isoniazid to 3 months of weekly rifapentine plus isoniazid, 3 months daily rifampicin plus isoniazid or 4 months of daily rifampicin alone.

“As people around the globe come together to commemorate World TB Day, WHO is calling on governments, affected communities, civil society organizations, health care providers, donors, partners and the industry to unite forces and step up the TB response ... to ensure no one is left behind,” said Tereza Kasaeva, MD, PhD, director of WHO’s Global TB Programme, said in the release. “The new WHO guidance shows the way forward for millions to rapidly access new tools and shorter, safer options for preventive treatment. The time for action is now.” – by Caitlyn Stulpin

Tedros Adhanom Ghebreyesus

WHO has issued updated guidance meant to decrease the development and transmission of tuberculosis in conjunction with World TB Day, which is observed every year on March 24.

According to WHO, a quarter of the world’s population is estimated to be infected with TB bacteria. While these individuals are neither sick with TB nor contagious, they are at greater risk for developing TB disease, the world’s top infectious killer. In 2018, 10 million people were diagnosed with TB worldwide and 1.5 million people died from it.

“The world committed to end TB by 2030. Improving prevention is key to making this happen,” WHO Director-General Tedros Adhanom Ghebreyesus, PhD, MSc, said in a release. “Millions of people need to be able to take TB preventive treatment to stop the onset of disease, avert suffering and save lives.”

Some progress has been made in meeting the goals for ending TB that were established at the UN Meeting on TB in 2018, but TB preventive treatment has been “largely neglected,” according to WHO. One such neglected target is guaranteeing access to preventive treatment by 2022 for at least 24 million contacts of people with active TB and 6 million people with HIV. According to WHO, to date, “only a fraction” of the target has been met. Countries provided TB preventive treatment to less than 430,000 contacts and 1.8 million people living with HIV in 2018.

WHO officials said that reinvigorated efforts are necessary to improve access to preventive treatment, a position that led to the new WHO guidelines.

In the new guidelines, WHO suggested a scale-up of preventive treatment for those at highest risk, including household contacts of patients with TB, people living with HIV and other people at risk, including those with lowered immunity or individuals living in crowded settings. The guidelines suggest that TB preventive treatment services are integrated into ongoing case-finding efforts for active TB. Such efforts include recommendations for screening all household contacts of patients with TB and people living with HIV for active disease. Per the guidelines, once active TB is ruled out, these populations should be started on preventive treatment.

The updated guidelines also recommended the use of either a tuberculin skin test or an interferon-gamma release assay in testing for TB infection. According to WHO, both are useful for finding people more likely to benefit from TB preventive treatment, but should not become a barrier to increasing access.

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Lastly, the updated WHO recommendations suggest new, shorter options for preventive treatment in addition to the broadly used regimen of 6 months of daily isoniazid. Options for shorter treatment include a 1-month daily regimen of rifapentine plus isoniazid to 3 months of weekly rifapentine plus isoniazid, 3 months daily rifampicin plus isoniazid or 4 months of daily rifampicin alone.

“As people around the globe come together to commemorate World TB Day, WHO is calling on governments, affected communities, civil society organizations, health care providers, donors, partners and the industry to unite forces and step up the TB response ... to ensure no one is left behind,” said Tereza Kasaeva, MD, PhD, director of WHO’s Global TB Programme, said in the release. “The new WHO guidance shows the way forward for millions to rapidly access new tools and shorter, safer options for preventive treatment. The time for action is now.” – by Caitlyn Stulpin