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Without treatment, 5 to 10 percent of people infected with TB will develop active TB.
The introduction of shorter regimens and the increase in 3HP in 2021 will offer several advantages at both a clinical and programmatic level. Image Credit: Flickr / Chris Piascik
Tuberculosis (TB) is one of the leading causes of illness and death worldwide. In 2019, 10 million people became ill with tuberculosis and about 1.4 million people died. The majority (95 percent) of the cases are in low- and middle-income countries.
It is estimated that a quarter of the world’s population is infected with TB, that is about 1.8 billion people. Most infected people have no symptoms and are not contagious. Most of them don’t even know they are infected, their TB is latent. If left untreated, latent TB infection can progress to TB disease, which makes people sick and can be passed from one person to another. This risk is highest among people with HIV and children under the age of five who share a home with people who have confirmed pulmonary tuberculosis.
Despite these high numbers, tuberculosis research has been critically underfunded for years. As a result, the development of tools to prevent and control tuberculosis has been delayed. For example, the Bacille Calmette Guerin (BCG) vaccine has been used for nearly a century and is effective in preventing serious illness in infants and young children. But it provides poor levels of protection against lung disease in adolescents and adults.
Treatment of tuberculosis infection remains the best option to prevent infected people from contracting the disease. Still very few people who are eligible for TB preventive treatment are taking it. When treatment has started, overall completion rates have been low due to the long duration of the regimes. The previous standard of care, isoniazid preventive therapy, was long and complex, and people had to take one pill a day for six to 36 months.
Shorter regimens are now being developed. My colleagues and I are part of a project seek ways to expand affordable short-term preventive therapy for tuberculosis. The goal of the four-year research project is to identify and provide new and shorter treatment options for people with latent TB infection. The goal is to slow down, and ultimately stop, the flood of new TB cases.
The project began with the implementation of a new regimen targeting people with HIV and children under five years of age in 12 high-burden countries. These include Pakistan, Zimbabwe, Malawi, Indonesia, Cambodia, Kenya, and Ethiopia. All have started to expand short-term regimes. South Africa, Namibia, Lesotho and Eswatini will also start in 2021 thanks to the support of development partners.
It could change the rules of the game for two reasons. The first is that short-term regimens of three months or one month can prevent tuberculosis in even more people than the current six-month regimen. And because it means that people are much more likely to complete their treatments.
New developments
Preventive treatment is given to people who are infected with or have been exposed to the bacteria and are at high risk of developing TB disease. This is essential to prevent progression from latent infection to disease and has been recommended for the past 23 years.
Without treatment, 5 to 10 percent of people infected with TB will develop active TB.
The efficacy of isoniazid and rifampin (3HP) combination therapies in preventing tuberculosis was established in 2018 after a large number of clinical trials. This was followed by the WHO publishes updated guidelines which recommended TB preventive treatment options that could help overcome several challenges. One included taking medication for long periods of time.
This catalyzed new innovations to reduce the number of pills needed and the time they had to take them. This included an ultrashort regimen combining isoniazid and rifapentine, once daily for one month (1HP).
Short-term regimens offer clear advantages in terms of better adherence and completion rates due to shorter duration of treatment and ease of use for children.
Fixed-dose combination treatments reduce the pill burden for adults taking 3HP from nine to three pills per week and for adults taking 1HP from six to four pills. These fixed-dose combination treatments are likely to improve treatment completion and health outcomes.
These regimens can be used by people living with HIV; the prevalence of tuberculosis is high in this population group. The choice of regimen should be based on multiple factors, including age, possible side effects, interactions with other medications, and individual preferences.
His an introduction will be necessary if the global goal of ending tuberculosis by 2030 is to be achieved.
The hope
Introducing shorter regimens and ramping up to 3HP in 2021 will offer several benefits at both a clinical and programmatic level.
By using brief regimens of three months or one month, we can prevent tuberculosis in even more people than the current six-month regimen. We can double or triple the numbers in the same period of time.
Once an affordable, child-friendly fixed-dose combination is available, 3HP may become the preferred regimen for the preventive treatment of tuberculosis at all ages. Children under 15 years of age counted 12 percent of the 10 million It is estimated that he was ill with tuberculosis in 2019 and it is estimated that 227,360 died of tuberculosis. By ensuring that children who need preventive treatment receive it, death from tuberculosis can be reduced.
This will significantly facilitate the administration of preventive tuberculosis treatment and support a family-centered approach to the management of tuberculosis infection.
Chihota violet, Principal Principal Scientist, Aurum Institute
This article has been republished from The Conversation under a Creative Commons license. Read the original article.
