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

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Pharmacotherapy

Background:

• Tuberculosis (TB) remains a significant global health challenge, particularly in high-burden countries like Pakistan.
• Preventive treatment for TB is crucial for controlling transmission, especially among household contacts.
• Evaluating different TB preventive treatment (TPT) regimens in real-world programmatic settings is essential for optimizing public health strategies.

Purpose of the Study:

• To compare treatment uptake and completion rates of two TPT regimens: 6 months of isoniazid (6H) and 3 months of isoniazid plus rifapentine weekly (3HP).
• To assess the effectiveness of these regimens in a programmatic setting in Pakistan among TB household contacts.
• To identify factors influencing TPT adherence and completion in a high TB-burden population.

Main Methods:

• A comparative study was conducted in Pakistan assessing TPT uptake and completion.
• Household contacts were clinically evaluated for TB disease before TPT initiation.
• Data were collected for contacts receiving 6H (October 2016-April 2017) and 3HP (May-September 2017) for ages ≥2 years, comparing outcomes.

Main Results:

• TPT uptake was similar between the 6H and 3HP groups (72% for both).
• Treatment completion was significantly higher for the 3HP regimen (67%) compared to the 6H regimen (46%).
• Individuals initiating 3HP had 2.3 times greater odds of completing treatment than those on 6H.

Conclusions:

• Shorter, weekly TPT regimens like 3HP are associated with higher completion rates among TB household contacts in programmatic settings.
• While TPT uptake was comparable, the improved completion with 3HP suggests it may be a more effective strategy for TB prevention in high-burden countries.
• Programmatic implementation of shorter TPT regimens can enhance adherence and potentially reduce TB transmission within households.