Questions and Answers
What is the primary consideration before initiating TB Preventive Therapy (TPT) in clients starting ART or already on ART?
In which scenario may TB Preventive Therapy (TPT) and ART be initiated on the same day?
What is the recommended treatment and duration for TB Preventive Therapy (TPT) in adults or adolescents ≥ 15 years (non-pregnant)?
Which of the following clients is eligible for TB Preventive Therapy (TPT) regardless of CD4 count?
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What is the recommended treatment and duration for TB Preventive Therapy (TPT) in children living with HIV who are < 15 years of age?
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In which age group is sputum testing attempted in children who can expectorate spontaneously?
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What is not required prior to starting TB Preventive Therapy (TPT)?
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In which scenario may Rifapentine and isoniazid weekly (3HP) be available as an alternative treatment for TB Preventive Therapy (TPT)?
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Study Notes
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
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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.
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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.
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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.
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Description
Learn about the assessment and initiation of TB Preventive Therapy (TPT) for clients on Antiretroviral Therapy (ART), including ruling out active TB and testing protocols. Understand the relationship between TPT and ART initiation.
