WHO announces updates to its forthcoming guidelines on TB preventive treatment

This will help national tuberculosis (TB) programmes, public and private healthcare providers, funders and other stakeholders to prepare for the changes, which will be introduced when the updated guidelines and accompanying operational handbook on TPT are released later this year, the WHO stated in its rapid communication.

According to the WHO, effective TPT in people at the highest risk of progression safely reduces the likelihood of developing TB disease. This includes individuals exposed to multidrug- or rifampicin-resistant TB (MDR/RR-TB).

The updated guidance, to be released later this year, will avail of the latest evidence and best available practices on TPT regimens for individuals of all ages in contact with TB patients and dosing schedules.

It will also incorporate current recommendations on screening strategies to rule out TB disease before starting TPT and the use of tests for TB infection, the WHO stated.

The WHO said the primary update is a recommendation to use a regimen of 6 months of levofloxacin as TPT for contacts of patients with multidrug- or rifampicin-resistant tuberculosis (MDR/RR-TB), based on the results of two randomized controlled trials in South Africa and Vietnam that supported the use of the regimen in all age-groups.

Other revisions include updated drug dosages for TPT regimens with rifapentine and levofloxacin, integration of recommendations on screening strategies to rule out tuberculosis ahead of starting TPT and the use of TB tests, and an update of the algorithm for TPT management in contacts.

"This Rapid Communication is being issued to help national TB programmes and other stakeholders prepare for the changes that will be introduced with the update of guidelines on TPT," the WHO said.

Scaling up TPT is considered a critical component of the WHO's End TB Strategy. In September 2023, United Nations (UN) Member States committed to increasing TPT coverage among contacts and people with HIV, to reach 45 million people by 2027.