Implementing TB preventive therapy: lessons from a large-scale initiative in India

Area of Science:

• Public Health
• Infectious Diseases
• Clinical Trials

Background:

• Tuberculosis (TB) remains a significant global health challenge.
• Shorter duration TB preventive treatment (TPT) regimens are increasingly recommended by the WHO.
• The Joint Effort for Elimination of Tuberculosis (JEET) project in India is evaluating new TPT strategies.

Purpose of the Study:

• To assess the early implementation findings of the 3-month rifapentine-isoniazid (3HP) regimen for TB preventive treatment.
• To compare the characteristics, adverse events, and treatment outcomes of 3HP with the standard 6-month daily isoniazid (6H) regimen.
• To evaluate the feasibility and effectiveness of 3HP in a real-world setting in India.

Main Methods:

• A descriptive cohort study was conducted involving household contacts (HHCs) of pulmonary TB patients.
• HHCs received either 3HP or 6H TPT in select districts.
• Data on HHC characteristics, adverse events (AEs), and TPT completion were collected and compared between the two groups.

Main Results:

• A total of 635 HHCs were initiated on 3HP, and 24,350 HHCs received 6H.
• Approximately 10% of HHCs on 3HP experienced AEs, compared to 4% on 6H.
• TPT completion rates were significantly higher for 3HP (95%) compared to 6H (84%, P < 0.001).

Conclusions:

• The 3HP regimen achieved high TPT completion rates with a low incidence of manageable adverse events.
• These findings support the expansion of the 3HP regimen within national TB programs.
• 3HP presents a promising and effective shorter TPT option for high-TB-burden countries.