The Growing Importance of Tuberculosis Preventive Therapy and How Research and Innovation Can Enhance Its Implementation on the Ground

Abstract

Ending the tuberculosis (TB) epidemic by 2030 requires two key actions: rapid diagnosis and effective treatment of active TB and identification and treatment of latent TB infection to prevent progression to active disease. We introduce this perspective by documenting the growing importance of TB preventive therapy on the international agenda coupled with global data showing poor implementation of preventive activities in programmatic settings. We follow this with two principal objectives. The first is to examine implementation challenges around diagnosis and treatment of active TB. Within this, we include recent evidence about the continued morbidity and heightened mortality that persists after TB treatment is successfully completed, thus elevating the importance of TB preventive therapy. The second objective is to outline how current TB preventive therapy activities have been shaped and are managed and propose how these can be improved through research and innovation. This includes expanding and giving higher priority to certain high-risk groups including those with fibrotic lung lesions on chest X-ray, showcasing the need to develop and deploy new biomarkers to more accurately predict risk of disease and making shorter treatment regimens, especially with rifapentine-isoniazid, more user-friendly and widely available. Ending the TB epidemic requires not only cure of the disease but preventing it before it even begins.

Isoniazid Adherence Reduces Mortality and Incident Tuberculosis at 96 Weeks Among Adults Initiating Antiretroviral Therapy With Advanced Human Immunodeficiency Virus in Multiple High-Burden Settings

“…Potential strategies to improve IPT uptake and completion include integration of TB and HIV care [ 37 ], TB training for HIV providers [ 34 ], community-based delivery of IPT, video directly observed therapy via smartphone platforms [ 38 , 39 ], use of adherence devices, such as medication event reminder monitor systems (MERMS), and interventions targeting groups with lower completion rates, such as younger patients and males [ 35 ]. In addition, clinical trials have recently evaluated shorter 3-month and 1-month TB prevention regimens containing isoniazid and rifapentine, which have similar efficacy as 60- to 9-month IPT, but better completion and adherence rates [ 40 ], and may alleviate the fear of potential isoniazid resistance (ie, due to poor adherence to a 6-month, 1-drug regimen for prevention).…”

Treating latent tuberculosis infection (LTBI) with isoniazid and rifapentine (3HP) in an inner-city population with psychosocial barriers to treatment adherence: A qualitative descriptive study

“…Lowering the pill burden by using a simpler fixed-dose combination (e.g. three tablets combined rifapentine 300mg and isoniazid 300mg) may improve treatment acceptance and adherence rates [47]. Furthermore, streamlining of pre-treatment requirements to reduce delays to treatment initiation may also improve uptake and adherence.…”

“…As a symptom of social inequity, TB requires socioeconomic interventions, including addressing the root causes of homelessness [49]. At scale, national poverty reduction has been shown to reduce TB incidence and reductions in TB incidence have been made through improvements in socioeconomic conditions [47,50,51]. While our study identified ways to support and facilitate preventive therapy access, uptake and completion, we do not intend to draw attention away from the social conditions that render persons vulnerable to exposure to M.tb and progression to disease.…”

The TB REACH Initiative: Supporting TB Elimination Efforts in the Asia-Pacific

“…In this series, Harries et al presents a strong argument for the importance of including treating TB infection as we move to end TB [ 49 ]. We note that while ACF has found a strong following in the last ten years, the scale up of TPT has seen many obstacles.…”