TB Preventive Therapy Overview

TB Preventive Therapy Overview

• All clients starting or already on ART should be assessed for TB Preventive Therapy (TPT) if not previously received.
• Active TB must be ruled out through clinical evaluation and testing prior to TPT initiation.
• TPT can begin without delay if a client is asymptomatic, even if TB GeneXpert results are pending.
• TPT and ART may be initiated on the same day.
• Tuberculin skin test (TST) is not a prerequisite for starting TPT.
• TB testing varies by age; younger children cannot spontaneously expectorate sputum, impacting testing requirements.

Client Categories and Treatment Recommendations

• Adults and Adolescents (≥ 15 years, non-pregnant)

  • Any CD4 count is acceptable.
  • Must exclude active liver disease, alcohol abuse, or hypersensitivity to isoniazid.
  • Recommended treatment: Isoniazid 300 mg daily for 12 months, with pyridoxine 25 mg daily.
  • Rifapentine and isoniazid weekly (3HP) may be available in select locations.

• Children living with HIV (< 15 years)

  • Applicable from 14 weeks of age during their first HIV and ART evaluation.
  • Significant TB exposure qualifies all children, including neonates.
  • Treatment: Isoniazid 10 mg/kg/day for 6 months (maximum 300 mg daily) with daily pyridoxine.

• Pregnant Women

  • Any CD4 count is permitted.
  • Must exclude active liver disease, alcohol abuse, or hypersensitivity to isoniazid.
  • Treatment: Isoniazid 300 mg daily for 12 months, with pyridoxine 25 mg daily.

Alternative Treatment Options

• Clients ≥ 25 kg on a DTG-containing regimen with VL < 50 c/mL in the past 6 months may use the 3HP regimen if available.
• 3HP is not recommended for new clients starting a DTG-containing regimen; 12H remains the preferred TPT regimen.
• If 12H or 3HP is prescribed, no extra clinician review visits are necessary; entire course can be scripted for 3 months of 3HP or 6 months of 12H.