Implementing 3HP vs. IPT as TB preventive treatment in Pakistan

Abstract

BACKGROUND: We assessed treatment uptake and completion for 6 months of isoniazid (6H) and 3 months of isoniazid plus rifapentine weekly (3HP) in a programmatic setting in Pakistan.METHODS: All household contacts were clinically evaluated to rule out TB disease. 6H was used for TB preventive treatment (TPT) from October 2016 to April 2017; from May to September 2017, 3HP was used for contacts aged ≥2 years. We compared clinical evaluation, TPT uptake and completion rates between contacts aged ≥2 years in the 6H period and in the 3HP period.RESULTS: We identified 3,442 contacts for the 6H regimen. After clinical evaluation, 744/1,036 (72%) started treatment, while 46% completed treatment. In contrast, 3,722 contacts were identified for 3HP. After clinical evaluation, 990/1,366 (72%) started treatment, while 67% completed treatment. Uptake of TPT did not differ significantly between the 6H and 3HP groups (OR 1.03, 95%CI 0.86–1.24). However, people who initiated 3HP had 2.3 times greater odds (95% CI 1.9–2.8) of completing treatment than those who initiated 6H after adjusting for age and sex.CONCLUSION: In programmatic settings in a high-burden country, household contacts of all ages were more likely to complete TPT with shorter weekly regimens, although treatment uptake rate for the two regimens was similar.

Implementation of tuberculosis preventive therapy with INH‐Rifapentine (3HP) for latent tuberculosis infection management in household tuberculosis contacts in India: A prospective study

“…In this study, lack of willingness for TST screening among the contacts was primarily due to lack of symptoms related to TB disease, and the concern over opportunity and travel costs incurred in travel to the health facility for undergoing screening. These findings are consistent with a study in Pakistan [17]. Another prospective study in Peru observed that transport vouchers increased the acceptability of TPT among household contacts of TB cases signifying potential usefulness of similar interventions in contacts belonging to economically vulnerable categories in India [20].…”

“…In this study, nearly six in 10 TB household contacts were LTBI positive which is nearly double the prevalence in the general population [13], and also higher compared to the findings in a South Indian study (52.6%) [23]. Increasing age was the only sociodemographic factor which had significantly higher odds of LTBI positivity in the present study which is consistent with the previous evidence where association of sociodemographic factors was lacking except for sleeping on the same bed [17, 23]. These findings provide corroborative evidence and further programmatic justification to expand the coverage of TPT selectively among household TB cases in the road to TB elimination for high TB burden countries.…”

“…TPT completion rates in the present study were higher compared to studies in Pakistan, USA and Peru [17,20,21]. Furthermore, the study in Pakistan included participants in all age-groups but observed the highest treatment completion rates with 3HP in the 6-14 age-group which was excluded from the present study [17].…”

“…Adverse event profile of 3HP is considered favourable compared to alternative regimens in previous studies [9, 17]. The 3HP regimen is also considered superior to 9HP in terms of lower risk of hepatotoxicity [11].…”

“…Nevertheless, till date, there is no comprehensive report from India on the feasibility and acceptability of 3HP regimen and their treatment completion and safety profiles in a programmatic setting. In contrast, study from Pakistan, a low‐income country from South Asia observed that within a programmatic setting, 72% of eligible household contacts were initiated while 67% completed the treatment [17]. A previous study from Delhi, India observed that nearly one in four household contacts of existing individuals with TB were unwilling to be initiated on TPT primarily due to the lack of perceived susceptibility and the fear of drug side effects [18].…”