CDST_LT: TB preventive therapy

TPT treatment options recommended under NTEP include:

• 3-month weekly Isoniazid and Rifapentine (3HP)
• 6-months daily isoniazid (6H)

Table 1: TPT Options for Target Population; Source: (Guidelines for Programmatic Management of Tuberculosis Preventive Treatment)

Table 2: TPT dosage based on age and weight band recommended by NTEP; Source: Guidelines for Programmatic Management of Tuberculosis Preventive Treatment

Resources

• Guidelines for Programmatic Management of Tuberculosis Preventive Treatment
• National Strategic Plan for TB Elimination

Assessment

The eligibility for TB Preventive Treatment (TPT) relies on ruling out active TB among individuals and groups who are known to have a high risk of acquiring TB. 

Prioritization of the target population for TPT is based on elevated risk of progression from infection to TB disease or increased likelihood of exposure to TB disease: At-risk populations include:  

1. Expanded eligible group including children >5 years, adolescents and adult Household Contacts (HHC) of pulmonary* TB patients notified in Nikshay from public and private sector (*bacteriologically confirmed pulmonary TB patients will be prioritized for enumeration of the target population for TPT)

Table 1: Target Population (Expanded Eligible Groups); Source: Guidelines for Programmatic Management of Tuberculosis Preventive Treatment.  

(*bacteriologically confirmed pulmonary TB patients will be prioritized for enumeration of the target population for TPT)

TPT reduces the overall risk for TB by 60-90% among People Living with HIV (PLHIV). Adults and children (>12 months) living with PLHIV should be screened for TB using a four-symptom complex and TPT can be provided to those without symptoms or after ruling out active TB in those with TB symptoms.  

All HHC of pulmonary TB patients is at substantially higher risk for progression to active TB than the general population. Hence, all HHC of pulmonary TB patients, regardless of their age, should be given TPT after ruling out TB. In children HHC under 5 years of age, TPT will be offered after ruling out active TB, without testing for TB infection. In children, HHC >5 years and adults, chest X-rays and testing for TB infection would be offered wherever available.

2. Expanded to other risk groups 

Individuals in other risk groups include those on immunosuppressive therapy, having silicosis, on anti-TNF treatment, on dialysis, and preparing for organ or haematologic transplantation.  

Systematic TB infection testing and treatment are not recommended for people with diabetes mellitus, malnutrition, smoking, or harmful alcohol abuse unless they have other risk factors for TB, such as HIV infection or a history of contact with TB patients within their household. 

Table 2: Target Population (Other Risk Groups); Source: Guidelines for Programmatic Management of Tuberculosis Preventive Treatment.   

Resource 

Guidelines for Programmatic Management of Tuberculosis Preventive Treatment. 

Assessment 

For TB infection, there are two recommended tests which can be used to identify such patients.

Tuberculin Skin Test (TST)

The skin test is done by injecting a small amount (0.5 ml) of TB antigens into the top layer of skin on your inner forearm. If one has ever been exposed to TB bacteria (Mycobacterium tuberculosis), there will be a reaction indicated by the development of a firm red bump (induration) >= 10 mm at the site within 2 days.

Image

Figure: Tuberculin Skin Test

Interferon-gamma release assay (IGRA)

IGRA is a Blood test. If one has been exposed to TB bacteria, the white blood cell in the blood will release a substance called gamma interferon when the cells are exposed to specific TB antigens.

Image

Figure: Interferon-gamma release assay (IGRA)

Resources:

• Latent Tuberculosis Infection Guideline
• Guideline for Programmatic Management of Tuberculosis Preventive Treatment in India

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The following TPT treatment options are recommended under NTEP once active TB has been ruled out:

Post-treatment TPT for PLHIV: In patients previously treated for TB, post-treatment TPT has been considered in view of the 5-7 times higher risk of recurrence of TB among PLHIV and nearly 90% of these due to re-infection. Thus, all CLHIV/PLHIV who had successfully completed treatment for TB disease earlier should receive a course of TPT after completing treatment of TB.

Resources 

• Guideline for Programmatic Management of Tuberculosis Preventive Treatment in India

• Consolidated Guidelines on Tuberculosis: Module 1: Prevention: Tuberculosis Preventive Treatment, 2020

• Latent TB Infection : Updated and Consolidated Guidelines for Programmatic Management, WHO, 2018

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