Tuberculosis preventive treatment: the next chapter of tuberculosis elimination in India.

Moonan, P.K .; Nair, S.A .; Agarwal, R .; Chadha, V.K .; Dewan, P.K .; Gupta, U.D .; Ho, C.S .; Holtz, T.H .; Kumar, A.M .; Kumar, N .; Kumar, P .; Maloney, S.A .; Mase, S.R .; Oeltmann, J.E .; Paramasivan, C.N .; Parmar, M.M .; Rade, K.K .; Ramachandran, R .; Rao, R .; Salhorta, V.S .; Sarin, R .; Sarin, S .; Sachdeva, K.S .; Selvaraju, S .; Singla, R .; Surie, D .; Tonsing, J .; Tripathy, S.P .; Khaparde, S.D.

BMJ Global Health; 2018; 3(5): e001135.   

Abstract: The End TB Strategy envisions a world free of tuberculosis—zero deaths, disease and suffering due to tuberculosis by 2035. This requires reducing the global tuberculosis incidence from >1250 cases per million people to <100 cases per million people within the next two decades. Expanding testing and treatment of tuberculosis infection is critical to achieving this goal. In high-burden countries, like India, the implementation of tuberculosis preventive treatment (TPT) remains a low priority. In this analysis article, we explore potential challenges and solutions of implementing TPT in India. The next chapter in tuberculosis elimination in India will require cost-effective and sustainable interventions aimed at tuberculosis infection. This will require constant innovation, locally driven solutions to address the diverse and dynamic tuberculosis epidemiology and persistent programme monitoring and evaluation. As new tools, regimens and approaches emerge, midcourse adjustments to policy and practice must be adopted. The development and implementation of new tools and strategies will call for close collaboration between local, national and international partners—both public and private—national health authorities, non-governmental organisations, research community and the diagnostic and pharmaceutical industry. Leading by example, India can contribute to global knowledge through operational research and programmatic implementation for combating tuberculosis infection .

Summary box:

✓ An estimated 354 million people are latently infected with tuberculosis in India and form the next generation of future tuberculosis cases.

✓ TB preventive treatment (TPT) can reduce rates of progression from infection to active TB disease by 90%. Yet in many high-burden countries, like India, the implementation of TPT remains a low priority, is underused and often avoided in practice.

✓ TPT will play a major role in bending the epidemiologic curve in India and will require constant innovation, locally-driven solutions, and persistent programme monitoring and evaluation.

✓ Leading by example, India can contribute to global knowledge of TPT through research and programmatic implementation

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