Expanding access to this intervention for high risk groups could save millions of lives
UNITAID’s announcement today to invest in new, shorter preventive treatment regimens and make them more accessible to key affected populations marks a big step forward in global efforts to end TB by 2030. This is a key target of the UN Sustainable Development Goals and WHO’s End TB Strategy.
An important component of the End TB Strategy is preventing TB among those most vulnerable to developing disease – including people living with HIV, children under 5, and miners. An estimated one-third of the world’s total population has latent tuberculosis, which means they have been infected by the TB bacteria but are not yet ill with the disease and cannot transmit it. “UNITAID’s funding will be catalytic in expanding access to this intervention for key affected populations and drive the development of much-needed innovative tools for TB prevention,” said Dr Mario Raviglione, Director of the World Health Organization’s Global TB Programme. “This could save millions of lives.”
Children under the age of five and people living with HIV are at much higher risk of developing active tuberculosis – and are more likely to die from it. People living with HIV, for example, are on average 30 times more likely to develop active tuberculosis following initial infection with the disease.
Given that TB is the most common illness and cause of death among people living with HIV, investing in the management of latent TB infection (LTBI) is critical. LTBI management, which includes systematic testing and treatment of high risk groups, is critical for TB elimination, particularly in low TB incidence countries where a large proportion of cases are due to reactivation of an old latent (or dormant) infection.
Achieving ≥ 90% LTBI treatment coverage among people living with HIV and child contacts of TB cases is one of the global priority targets of the Strategy. WHO recommends a two-pronged approach, in which: (1) treatment for LTBI should be provided in all countries at least to people living with HIV and children aged less than 5 years old who are household or close contacts of a TB case and (2) treatment for LTBI should be provided to additional risk groups in low TB burden countries, especially highly vulnerable people with certain medical conditions.
However, this intervention has unfortunately been slow in uptake by countries. Currently only 23% of countries globally reported using isoniazid preventive therapy (IPT) in 2014. 60% of people living with HIV reported to be using IPT are in South Africa, which is a pathfinder in expanding access to TB preventive therapy and other innovations.
Looking ahead, given its impact on market dynamics, UNITAID financing can help promote the scale up of shorter regimens for TB prevention and also drive the development of new drugs/regimens (including a fixed-dose combination of the currently recommended short regimen) and diagnostics to improve reliability of tests to detect latent TB infection.
“We applaud UNITAID’s new call for proposals and hope that today’s announcement will bring the much-need attention and investment in TB preventive treatment which remains a highly neglected area,” said Dr Raviglione.
Quick facts
3 out of 10 people globally are thought to have latent TB infection (2-3 billion).
- 60-90% risk reduction of developing active TB with currently available treatment .
- 10-15% of people infected with TB bacteria have a lifetime risk of developing active TB disease.
- Globally people living with HIV are on average 30 times more likely to develop active TB disease than those without HIV.
- Nearly 1 million people living with HIV are on IPT – but only 23% of countries globally reported using IPT in 2014 (13 of the 41 TB/HIV burden countries). 60% of people living with HIV reported to be using IPT are in South Africa.