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Support from a global consortium will expand access to shorter TB prevention options, help advance efforts towards TB elimination across seven counties
The Unitaid-funded IMPAACT4TB Consortium, led by the Aurum Institute, announced on 23 March that it will provide 250,000 patient courses of short course rifapentine-based preventive treatment regimens to seven countries to help prevent tuberculosis (TB). The patient courses will include the three-month 3HP regimen, and the even shorter 1HP, which is only taken for 28 days. This contribution is part of the Consortium’s ongoing efforts to end TB and improve global health outcomes.
The seven countries set to benefit from this initiative are Brazil, Haiti, India, the Maldives, Nigeria, Tanzania and Zambia. This supply of rifapentine-based preventive treatment regimens is expected to contribute significantly to the global effort to reduce the incidence of TB, which continues to be a major public health challenge worldwide.
“Despite commitments to end tuberculosis as a global epidemic by 2030, the disease remains the world’s deadliest infectious disease, killing around 4,400 people every day,” said Prof Gavin Churchyard, CEO of Aurum Institute and the principal investigator of the IMPAACT4TB project. “TB prevention is a cornerstone of any effort to eliminate TB, and we hope that these 250,000 patient courses will contribute to countries’ efforts to finally make TB a disease of the past.”
About one-quarter of the world’s population is infected with a form of TB that causes no symptoms and is not contagious. Without treatment, 5% to 10% of those infected will develop active TB, which causes severe illness and can be transmitted from person to person through the air. TB preventive treatment regimens lower the risk of progression to TB in people at risk, including children, pregnant women, and people living with HIV.
In recent years, new and shorter rifapentine-based TB preventive treatment regimens have been recommended by the World Health Organization (WHO) and are becoming increasingly available. Currently, over four million patient courses are being manufactured annually. These shorter regimens are associated with higher treatment adherence, completion, and outcomes. In fact, people taking shorter regimens are up to three times more likely to complete their course than those on longer regimens—leading to better outcomes and more lives saved.
In many high-burden TB countries, these new short-course TB preventive treatment regimens are modelled to be cost-effective for both people living with HIV and household contacts of all ages, regardless of whether contact investigation is already in place.
“The seven countries receiving these regimens have expressed their readiness not only to identify underserved and at-risk populations and ensure they receive these newer regimens, but also to invest in strengthening systems around contact tracing and learning lessons on how to improve TB preventive treatment uptake and coverage,” said Dr Philippe Duneton, Executive Director of Unitaid.
These patient courses consist of shorter rifapentine-based regimens, including two treatment options: 3HP, a three-month oral treatment taken once weekly, and 1HP, a 28-day oral treatment taken once daily, increasing choice for patients needing TB preventive treatment. Access to rifapentine-based regimens has been established in 71 countries, with over three million patient courses purchased to date. However, despite this progress, key groups and areas are still behind target.
The IMPAACT4TB Consortium’s provision of patient courses, which was made possible due to cost savings achieved over the past five years, is part of the Consortium’s broader strategy to reduce the cost of rifapentine. Among other things, by working with global partners and manufacturers, the Consortium helped significantly reduce the access price of a three-month patient course of weekly rifapentine and isoniazid, from US$72 to US$14.25.
In addition to providing the patient courses, the IMPAACT4TB Consortium will also provide technical assistance to countries in their implementation efforts, including identifying populations that could benefit from TB prevention, and determining the most appropriate regimen for them. The project actively advocates for universal access to TB prevention tools through their #RightToPreventTB campaign to raise awareness within communities about effective prevention regimens.
In 2021 alone, close to 1.6 million people died from TB, while around 10.6 million people fell ill from the disease. Currently, the world is not on track to achieve the TB prevention targets set at the United Nations High-Level Meeting on TB held in 2018. While significant progress has been made in providing TB prevention to people living with HIV, the number of household contacts receiving TB preventive treatment remains unacceptably low. In fact, the current progress towards the target of providing tuberculosis preventive treatment (TPT) to 30 million people by 2022 is only at 42%, indicating a critical need for stronger efforts to scale up TPT for household contacts.