Tuberculosis Preventive Therapy

TB PREVENTIVE THERAPY (TPT)TB preventive Therapy (TPT) remains one of the main stay of TB prevention. The following group of patients are targeted for latent TB treatment using isoniazid or Rifapentine in combination with Isoniazid

Household contact

Under-five children who are household contact of pulmonary TB cases and who are found not to have active TB on an appropriate clinical evaluation
HIV negative adult contacts of pulmonary TB cases

PLHIV

Children living with HIV who are >12 months of age who screen negative for TB using the ICF tool.
Children living with HIV who are <12 months of age, who have contact with a PTB and screen negative for TB using the ICF tool.
All adult PLHIV above who screen negative for TB using the ICF tool.

Overview of TPT Regimens

Regimen	Description	Target Population	Frequency	Duration of Treatment	Precautions/ Recommendations
Isoniazid preventive Therapy	A single dose formulation of Isoniazid (INH)	Children of all ages	Once daily	6 Months 180 doses	Preferred Regimen for HIV-infected children taking lopinavir-ritonavir, nevirapine, or dolutegravir,
3HP	A short course TPT regimen that combines Isoniazid and Rifapentine	Adults and children ≥2 years old	Once weekly	12 weeks 12 doses	Safe to give with dolutegravir-based ART in Adults Reduces lopinavir-ritonavir and nevirapine levels. Do not use or use with dose adjustment for HIV-infected children taking lopinavir-ritonavir, nevirapine, or dolutegravir
3RH	A short course TPT regimen that combines Isoniazid (INH) and Rifampicin (R)	Children of all ages	Once daily	12 Weeks 90 doses	Reduces lopinavir-ritonavir and nevirapine levels. Do not use or use with dose adjustment for HIV-infected children taking lopinavir-ritonavir, nevirapine or dolutegravir.

Note: It is important to note that RIF and RPT are potent inducers of the cytochrome P450 oxidase system. Their administration may affect the pharmacokinetics of other drugs including some antiretrovirals (ARVs). For people living with HIV/AIDS, both 3HP and 3RH are safe to give with efavirenz-based ART without any dosing adjustments. In adults, 3HP is safe to give with dolutegravir-based ART without any dosing adjustment. Both 3HP and 3RH reduce lopinavir-ritonavir and nevirapine levels. Thus, dosing adjustments are needed. So, neither can be used together with lopinavir-ritonavir or nevirapine. As a consequence, for HIV-infected children taking lopinavir-ritonavir, nevirapine, or dolutegravir, the preferred TPT regimen is represented by 6H (preferably with the dispersible formulation), which does not require dose adjustment.

TB PREVENTIVE THEPARY AMONGST ADULTS

3HP Regimen

The table below summarizes the weight banded dosing for 3HP amongst individuals above 14 years (classified as adults).

3HP dosage by weight band for Adults (>14 years)

Age	>14 Years
Medicine formulation	30 - 35kg	36 - 45kg	46 - 55kg	56 - 70kg	>70kg
FDC Rifapentine /Isoniazid (300/300mg)	3	3	3	3	3

TB PREVENTIVE THEPARY AMONGST CHILDREN

The section below summarizes weight banded dosing for TB Preventive Therapy regimens amongst children.

Isoniazid preventive Therapy dosage for children under 5

For all under 5 children who are contacts of pulmonary TB patients, the recommended dosing of Isoniazid Preventive Therapy (IPT) is 10 mg/kg once daily for 6 months

3HP dosage by weight band for children (2-14 years)

Age	2 – 14 Years
Medicine formulation	10 - 15kg	16 - 23kg	24 - 30kg	31 - 34kg	>34kg
Isoniazid 100mg	3	5	6	7	7
Rifapentine 150mg	2	3	4	5	5

*3HP is an option for TPT amongst children but not a preferred regimen because there are no child friendly formulations yet on the market. The use of 3HP amongst children will be considered as optimized formulations become available on the market.

3RH dosage by weight band for children (same with the dosages for treatment)

Body Weight	RH 75/50 Number of tablets
4-7kg	1
8-11kg	2
12-15kg	3
16-24kg	4
25 +kg