Union led paper says TB prevention has to be better embraced, properly implemented and scaled up

A new article discussing the research and innovation needed to improve the uptake and delivery of tuberculosis (TB) preventive therapy has been published by The Union’s Centre for Operational Research, Union consultants and the World Health Organization (WHO)’s Special Programme for Research and Training in Tropical Diseases (TDR). The perspective article was published in the open access journal Tropical Medicine and Infectious Diseases, titled The growing importance of TB preventive therapy and how research and innovation can enhance its implementation on the ground.

While the prevention of TB makes intuitive public health sense, it has been a relatively neglected component of TB control efforts until the last five or six years. Thanks to WHO’s End TB Strategy and the United Nations High-Level Meeting on TB, the role of preventive therapy has risen in importance on the international agenda. With operational shortfalls in the diagnosis and treatment of TB and the growing realisation that many TB survivors continue to experience significant illness and heightened mortality in the post-TB period, preventive therapy becomes even more important.

The implementation of TB preventive therapy on the ground, however, is sub-optimal, with targets for people living with HIV and household contacts being missed in almost every region of the world. The paper outlines the various components of WHO guidelines on the programmatic management of TB preventive therapy and then goes on to discuss the research and innovation that could improve delivery and uptake of this intervention. This includes expanding the high-risk groups eligible for preventive therapy, developing better tests for TB infection (also referred to as latent TB), making better use of chest radiography, expanding and redefining the use of the three-month course of weekly rifapentine and isoniazid, and improving recording and reporting. 

The paper concludes by asserting the need for improving and scaling up proven interventions and investing in and deploying new products, the most desirable of which is an affordable, point-of-care, easy to use biomarker to predict who is at risk of progressing to active TB disease.