13.5 TB Preventive Treatment (TPT)

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TPT is very effective in preventing active TB in individuals who have LTBI. All HIV-positive persons in whom active TB has been excluded should be started on TPT. Although Isoniazid TPT is the most widely used form of TPT, other regimens are also effective. The safety of isoniazid TPT has been well established, including in pregnant women and children. When administered correctly after ruling out active TB, isoniazid TPT has not been associated with development of isoniazid resistance. Risks of isoniazid TPT include isoniazid-induced hepatitis, peripheral neuropathy and inadequate treatment of persons with active TB with the potential development of isoniazid resistance. Strict adherence to laid down criteria for TPT eligibility, along with proper monitoring and follow-up, will minimise these risks.

13.5.1 Eligibility criteria for TPT in PLHIV

The individual, to be eligible for TPT, must:

  • Have no symptoms or signs of TB – current cough, fever, weight loss, night sweats, enlarged lymph nodes, or fatigue, blood in sputum, chest pain, diarrhoea, shortness of breath and loss of appetite,
  • Have no history of alcoholism,
  • Have no history of active liver disease, liver insufficiency, or jaundice,
  • Patients who are unwell; particularly in case of unexplained illness.
  • Have no history of hypersensitivity to isoniazid (if isoniazid TPT is being considered),
  • Have no history of exfoliative dermatitis, and
  • Be convinced and motivated enough to complete the full course of TPT after being counselled about the benefits, possible side-effects and risks.

13.5.2 When to initiate TPT

Same day ART and TPT initiation is recommended for newly diagnosed PLHIV who are eligible. All PLHIV on ART and not yet on TPT should be screened for TB at every visit and initiated on TPT as soon as eligible. PLHIV, who have successfully completed TB treatment, should be assessed for TPT with the aim of initiating a TPT course immediately after completing the full course of TB treatment.

All details of the person receiving TPT must be recorded as required in the TPT/IPT register and the TPT/IPT identity card or other patient-held records. TPT status should also be recorded in the HIV patient care booklet (if HIV positive). An outcome should be given to all patients registered for TPT.

13.5.3 Contraindications of TPT

Individuals with one or more of the following conditions should not receive TPT:

  • Active tuberculosis.
  • Symptoms compatible with tuberculosis, even if the diagnosis of TB cannot be confirmed.
  • Abnormal chest X-ray.
  • Diagnosis and treatment of TB in the past 3 years.
  • Poor prognosis (terminally ill AIDS patients).
  • History of poor compliance with treatment.
  • Active hepatitis (chronic or acute).
  • Known or reported high daily alcohol consumption.
  • Prior allergy or intolerance to isoniazid.
  • History of close contact with MDR-TB patient.