Tuberculosis preventive therapy uptake barriers: what are the low-lying fruits to surmount this?

Abstract

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Drop‐offs in the isoniazid preventive therapy cascade among children living with HIV in western Kenya, 2015–2019

“…Although TB preventive therapy (TPT) is critical to reducing morbidity and mortality associated with TB in people living with HIV, it remains underutilized, especially in high TB/HIV burden settings, including sub‐Saharan Africa (SSA) [ 17 ]. Our results add to the scant evidence on the programmatic performance of the TPT cascade in CLHIV from SSA.…”

Management of Tuberculosis Infection: Current Situation, Recent Developments and Operational Challenges

“…Fear of drug stock-outs, especially in peripheral centers, had been identified as the main cause of non-initiation of isoniazid preventive therapy [ 67 ]. In addition, operational and logistical issues may also lead to limited access to TBI screening and to TPT [ 68 ]; Lack of qualified human resources: The lack of qualified health care workers or the absence of training on how to prescribe TPT and convince asymptomatic individuals to undertake TBI screening or to take treatment may lead to distrust in health care workers [ 69 , 70 ]; Approach to screening and TPT: Routine screening for TBI may create anxiety and fear of stigma for individuals who do not feel sick. The WHO recommends decentralized, family-centered and integrated models of care to deliver services to children, adolescents and adults exposed to TB [ 71 ]; Diagnostic of TBI and active TB: The inherent limitations in the currently available tests for diagnosis of TBI as well as those for ruling out active TB and their limited availability in resource-poor countries are hampering wide programmatic management of TBI and may lead to the emergence of drug-resistance if TPT is not appropriately prescribed [ 72 ]; Availability of shortened regimens: The current high cost of rifapentine and the limited access to appropriate drug formulations, especially the dispersible rifapentine for infants, fixed-dose combinations for HP [ 41 ] and single-dose of rifampicin for 4R [ 23 ] are a further limit to the wide provision of TPT; Monitoring and evaluation: Few low- and middle-income countries (LMICs) have an established system for monitoring and evaluating the implementation of TPT [ 73 ].…”

“…Fear of drug stock-outs, especially in peripheral centers, had been identified as the main cause of non-initiation of isoniazid preventive therapy [ 67 ]. In addition, operational and logistical issues may also lead to limited access to TBI screening and to TPT [ 68 ];…”

Challenges in expanding TB preventive therapy in high-burden settings: beyond logistics is evidence and ethics

“…1 Masini et al have highlighted this public health challenge, wherein an estimated 30 million TPT-eligible beneficiaries globally are missed out due to operational and logistical issues. 2 Odume et al has also shown the effectiveness of addressing the procurement challenges of isoniazid (INH) in augmenting the acceptability and uptake of TPT among the PLHIV in Nigeria. 3 In high-risk populations such as PLHIV, who have an estimated 16-27 times higher risk of progression to TB disease, 1 logistical support, political will and financial commitments alone may be adequate in reaching and promoting TPT uptake in the target population.…”