New WHO recommendations to prevent tuberculosis aim to save millions of lives

A quarter of the world‘s population is estimated to be infected with TB bacteria. These people are neither sick nor contagious. However, they are at greater risk of developing TB disease, especially those with weakened immunity. Offering them TB preventive treatment will not only protect them from becoming sick but also cut down on the risk of transmission in the community.

As we mark World TB Day 2020, the disease remains the world’s top infectious killer. In 2018, 10 million people fell ill with TB worldwide and 1.5 million people lost their lives to this disease.

“COVID-19 is highlighting just how vulnerable people with lung diseases and weakened immune systems can be,“ said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “The world committed to end TB by 2030; improving prevention is key to making this happen. Millions of people need to be able to take TB preventive treatment to stop the onset of disease, avert suffering and save lives”.

Dr Tedros highlighted the importance to continue efforts to tackle longstanding health problems, including TB during global outbreaks such as COVID-19. At the same time, programmes already in place to combat TB and other major infectious diseases can be leveraged to make the response to COVID-19 more effective and rapid.

Although some progress has been made towards targets set at the UN high-level Meeting on TB in 2018, TB preventive treatment has been largely neglected. Global leaders committed to ensuring access to TB preventive treatment to at least 24 million contacts of people with active TB and 6 million people living with HIV by 2022.  To date only a fraction of that target has been reached, with countries putting less than 430,000 contacts and 1.8 million people on TB preventive treatment in 2018.

TB remains the top cause of death among people with HIV. TB preventive treatment works synergistically with antiretroviral therapy to prevent TB and save lives. Reinvigorated efforts by governments, health services, partners, donors and civil society will be needed to increase access to TB preventive treatment to the levels targeted.

The new consolidated guidelines recommend a range of innovative approaches to scale up access to TB preventive treatment:

• WHO recommends a scale-up of TB preventive treatment among populations at highest risk including household contacts of TB patients, people living with HIV and other people at risk with lowered” immunity or living in crowded settings.
• WHO recommends an integration of TB preventive treatment services into ongoing case finding efforts for active TB. All household contacts of TB patients and people living with HIV are recommended to be screened for active TB. If active TB is ruled out, they should be initiated on TB preventive treatment.
• WHO recommends that either a tuberculin skin test  or interferon-gamma release assay (IGRA) be used to test for TB infection. Both tests are helpful to find people more likely to benefit from TB preventive treatment but should not become a barrier to scale-up access. Testing for TB infection is not required before starting TB preventive treatment in people living with HIV, and children under 5 years who are contacts of people with active TB.
• WHO recommends new shorter options for preventive treatment in addition to the widely used 6 months of daily isoniazid. The shorter options that are now recommended range from a 1 month daily regimen of rifapentine plus isoniazid to 3 months 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 – notably for TB preventive treatment – to ensure no one is left behind,” said Dr Tereza Kasaeva, Director of WHO’s Global TB Programme. “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.”

TB preventive treatment is an affordable intervention that can prevent families from sliding into poverty and preserve the health and economy of whole communities. WHO anticipates that as new and safer drugs come onto the markets, and as prices fall, it will become a highly-cost effective way to save millions of lives.