Revised Guidelines on TB preventive therapy 2024

India has the highest estimated burden of tuberculosis infection (TBI) globally, with nearly 35-40 crores Indian population having TBI, of which 26 lakhs people (18-36 lakh) are estimated to develop tuberculosis (TB) disease annually. This may change after the ongoing national TB prevalence survey data becomes available.

Tuberculosis (TB) Preventive Treatment (TPT) is one of the key interventions recommended by World Health Organization
(WHO) to achieve the #EndTB Strategy goals, as upheld by the UN High Level Meeting on TB in September 2018.

Guidelines for Programmatic Management of Tuberculosis Preventive Treatment in INDIA are published by MOHFW in JULY 2021 under NTEP.

TARGET POPULATION FOR TB PREVENTIVE TREATMENT:

1) PLHIV (+ ART)

• Adults and children > 12 months
• Infants < 12 months with HIV in contact with Active TB

2) HHC < 5 years of pulmonary TB patients

3) HHC > 0r = 5 years of pulmonary TB patients

4) Individuals who are on

• Immunosuppressive therapy
• Having silicosis
• On anti-TNF treatment
• On dialysis
• Preparing for organ or hematologic transplantation

Strategy for TPT based on target population

* TPT to all after ruling out active TB disease (by CBNAAT)

• 1) PLHIV (+ ART)
  • Adults and children > 12 months
  • Infants < 12 months with HIV in contact with Active TB

  2) HHC < 5 years of pulmonary TB patients

* TPT after ruling out TB disease among TBI positive (TST or IGRA)

• 3) HHC > 0r = 5 years of pulmonary TB patients4) Individuals who are on
  • Immunosuppressive therapy
  • Having silicosis
  • On anti-TNF treatment
  • On dialysis
  • Preparing for organ or hematologic transplantation

TPT is contraindicated in the following situations:
• Active TB disease
• Acute or chronic hepatitis
• Concurrent use of other hepatotoxic medications (such as nevirapine)
• Regular and heavy alcohol consumption
• Signs and symptoms of peripheral neuropathy like persistent tingling, numbness and burning sensation in the limbs
• Allergy or known hypersensitivity to any drugs being considered for TPT

Note : Pregnancy or a previous history of TB are not contraindications for TPT

(TPT-TB Preventive Treatment, HHC-House Hold Contact, TBI-TB Infection, IGRA-Interferon Gamma Release Assay, TST-Tuberculin Skin Test, PLHIV-Patients Living With HIV).

Treatment Options:

Drug sensitive: 6H or 3HP or 1 HP

Drug-resistant: 4R or 6Lfx

(R-Rifampicin, Lfx-Levofloxicine, P-Rifapentin, H-Isoniazid)

Current update:

1HP is recommended instead of 3HP in PLHIV if Age > 13 years. (NACO Guidelines)