After various delays and setbacks, new, less toxic, short-course tuberculosis (TB) prevention therapy is finally being launched in six districts in
The new three-month treatment course, called 3HP, will initially only be provided to eligible people at risk of TB in the
While
Stepping up TB control
Professor Keertan Dheda, a pulmonologist and a critical care specialist who heads up the
"An additional aspect of TB control is to treat the sleeping form of TB (also called latent TB infection)," he says. "Persons that have the sleeping form of TB have no symptoms and their X-rays do not show any evidence of active TB. However, this form of TB can later transform into active TB making people ill and the bug can also be transmitted to other people at that stage. TB preventative therapy thus prevents TB months to years down the line and contributes to [the] overall control of TB."
He says it will be difficult to eradicate TB without using TB preventative therapy, as there will always be cases that will later pop up, amplifying disease spread and burden.
Professor Gavin Churchyard, founder and Chief Executive Officer of the
Traditionally TB preventive therapy involves taking the drug isoniazid every day for anything from six to 36 months - often referred to as IPT, (isoniazid preventive therapy).
A new and better alternative
But a number of new, short course alternatives have been shown to work equally well and to have the benefit of higher treatment completion rates in recent years. Most prominent among these is 3HP, the regimen now being phased in in
Churchyard says that compared to IPT, the 3HP regimen has clear advantages. This includes the shorter course, once-weekly dosing, and equal or less frequent adverse events.
Dr
Delays and setbacks
As previously reported in Spotlight, one reason 3HP has not been rolled out earlier in
"Ensuring all people at risk of TB can access rifapentine-based TB preventive therapy will require further reducing the price of rifapentine. The expected entry of additional generic manufacturers of rifapentine should put some downward pressure on price through competition and increased supply. But governments should not leave affordability to the market alone," he says.
"We know that under the right conditions rifapentine manufacturers can go lower than
But price was not the only delaying factor.
Mvusi points out that the COVID-19 pandemic and associated lockdowns around the world impacted the production and delivery of rifapentine to
This process, she says, took longer than expected and clearance of all stock already in the country was only obtained in
Yet, even though the rollout of 3HP in
Who is eligible for 3HP?
WHO guidance recommends TB preventive treatment for people living with HIV, household contacts of bacteriologically confirmed pulmonary TB cases, and clinical risk groups (e.g. those receiving dialysis).
Churchyard explains that in
According to Churchyard, the side effects of 3HP are uncommon and most people take TB prevention medicines without any problems. "Some patients using 3HP experience flu-like or other systemic drug reactions, with fever, headache, dizziness, nausea, muscle and bone pain, rash, itching, red eyes, or other symptoms. Clinicians should educate patients about possible adverse effects and instruct them to stop taking their medicine and to seek medical attention when signs and symptoms of adverse events first appear," he says.
When asked whether people will be given a three-month supply to take home, or if they will have to come back every month, Mvusi says dispensing will be aligned to the modalities of care that implementing districts are using to reduce patients in healthcare facilities to limit the spread of COVID-19.
"The dispensing method will also be influenced by the supply of rifapentine allocated to the district based on the projected eligibility numbers for TB preventive therapy," says Mvusi. "For example, some districts may issue three months at the first initiation, aligning to the multi-month dispensing program (MMD). They will give 3HP full three months (or six months isoniazid for Household contacts), some might align to the MMD programme, some may issue the first month's course, and align subsequent months to the MMD strategy used in the facilities. There are discussions to add 3HP into the provincial drug formularies so that it can be dispensed through Central Chronic Medicine Dispensing and Distribution (CCMDD). The feasibility of that is still being explored."
Mvusi also says that there will be a need to invest in remote pharmacovigilance and adherence support, considering the multi-month dispensing strategies under consideration.
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