Ending Tuberculosis with Preventive Therapy, several
million cases are diagnosed every year with a significant proportion of TB
related deaths. Optimal, and affordable treatment must be made accessible to
all, including those with latent TB,
who makeup nearly a fourth of the world's population and form a high-risk group in whom TB has to be prevented.
According to Prof Harry Hausler, Chief Executive Officer of
TB HIV Care in South Africa, "TB
preventive therapy (TPT) has been around for a long time but its rollout has
been suboptimal. South Africa is a country that has the biggest implementation
of TB preventive therapy as well as antiretroviral treatment in the
world. More than 400,000 people on TB preventive therapy were initiated last
year but that's still 53% of people who are newly enrolled in HIV
Know More About HIV care. We have
another 4.4 million South Africans living with HIV who are already on
antiretroviral treatment, but we do not
have data to say what proportion of them have access to TB preventive therapy.
So, we really do have a long way to go."
Four Pillars of Medical Ethics Help Eliminate TB
- Beneficence - Doing What is Beneficial
Giving treatment that is beneficial to
the person. In this context, the prevention of TB is
important. TB preventive treatment is effective and currently, several options are available
such as six months of isoniazid
(INH) therapy; and new treatment regimens as per the latest WHO guidelines,
namely 3 months of weekly rifapentine and INH which is as effective as three months of rifampicin and INH.
- Non-maleficence - Doing No HarmThe new regimen namely 3HP is less toxic to the liver and thus
safer, and patient compliance is also likely to
be better and to complete treatment than six months of isoniazid (INH).
3HP is one of
four regimens that Centers for
Disease Control and Prevention (CDC) recommends to treat
latent tuberculosis infection treat latent tuberculosis infection
Shorter Treatment Regime to Cure Latent Tuberculosis. The
term 3HP is derived from the length of treatment (once weekly doses for3 months)
and letters from the abbreviations of the two drugs (INH and RPT),
that make up the regimen. It is also referred to as the 12 dose regimen.
Esnath Manhiri from Zimbabwe national
network of people living with HIV, said: "People living with HIV are at very high risk of getting infected
by TB. My message for people living with
HIV is that let's go for TB Preventive Therapy (TPT). This new TPT regimen
is very short, has less side effects and the
treatment completion rate is very high. Let us encourage each
other to go for TPT so that we can prevent ourselves from getting infected by
- Autonomy and Justice
People should have the right to choose the regimen that they want, and
justice because rifapentine at the current price is not affordable to many.
Pharmaceutical companies must be urged
to bring down the price of rifapentine and make it accessible to all,
especially in high burden countries of Africa including South Africa.
Will and Governmental Support
All countries signed a political
declaration in September 2018 at the United Nations High-Level Meeting (UNHLM), pledging to bring 30 million people on TB
preventive treatment (TPT) by 2022, which includes 6 million HIV patients, 20
million household contacts and 4 million children under five years of age.
Suvanand Sahu, Deputy Executive Director, Stop TB Partnership, said
that the three key
factors to focus upon to making prevention of TB
- Raising available domestic resources, particularly in
high TB burden nations
- Identifying persons overlooked in the past
- Making heads of countries accountable, politicians and
leaders answerable for the
implementation of preventive measures and achievement of targets
In summary, eliminating TB poses a huge
challenge and governments, health workers, patients and the public must all
come together and make this ethically driven campaign a success and achieve
tuberculosis eradication by 2030.
- 3HP FAQs for Providers - (https://www.cdc.gov/tb/education/FAQforProviders.htm)
Source: Bobby Ramakant, CNS (Citizen News Service)