Doctors Revision

HIV, STI & TB

Tuberculosis Preventive Treatment (TPT)

Administration of anti-TB medication (e.g., Isoniazid, Rifapentine-based regimens) to individuals with latent TB infection (LTBI) to prevent progression to active TB disease. Primarily targeted at high-risk groups such as People Living with HIV (PLHIV) and close contacts of infectious TB cases.

Also known as: TPT, Latent TB Treatment, LTBI Treatment, INH Prophylaxis

Open in the interactive guide
On this page

Referral and warning signs

When to refer

  • Development of symptoms suggestive of active TB disease while on TPT.
  • Signs or symptoms suggestive of significant drug toxicity (e.g., jaundice, severe rash, persistent vomiting, severe neuropathy).
  • Known contact of an MDR-TB patient (requires specialist consultation for preventive options).
  • Patients with complex co-morbidities or potential drug interactions requiring specialist management.

Red flags

  • Development of cough, fever, weight loss, or night sweats while on TPT
  • Jaundice
  • Severe or persistent peripheral neuropathy symptoms
  • Severe skin rash

Signs and symptoms

  • Not applicable - TPT is for individuals WITHOUT signs/symptoms of active TB disease.
  • Eligibility requires screening for and absence of: Cough, Fever, Weight loss, Night sweats.

Risk factors

  • Being a Person Living with HIV (PLHIV)
  • Being a close contact (especially household contact) of a person with bacteriologically confirmed pulmonary TB.
  • Children < 5 years who are contacts of PTB cases.
  • Other immunosuppressed conditions (though guidelines focus on PLHIV/contacts).

Diagnosis

Clinical assessment

Eligibility assessment involves identifying individuals belonging to target groups (PLHIV, contacts). Crucial Step: Rule out active TB disease using a systematic symptom screen (absence of current cough, fever, weight loss, night sweats).

Investigations

  • TB Symptom Screen: Mandatory for all potential TPT candidates.
  • Chest X-ray: May be used to help rule out active pulmonary TB if symptom screen is unclear or in specific populations (though not routinely required for asymptomatic PLHIV/contacts in high-burden settings).
  • Tuberculin Skin Test (TST) / Interferon-Gamma Release Assay (IGRA): Can confirm latent infection but generally NOT required to initiate TPT in high-risk groups (PLHIV, child contacts <5) in high-burden settings like Uganda, once active TB is excluded.
  • Rule out contraindications to TPT medications (e.g., active liver disease, severe peripheral neuropathy, history of severe hypersensitivity).

Diagnostic criteria

Identification as eligible high-risk individual (PLHIV, TB contact) AND systematic exclusion of active TB disease (primarily via symptom screen).

Management

Non-pharmacological management

  • Counseling: Explain LTBI vs active TB, purpose of TPT, importance of adherence, potential side effects.
  • Adherence Support: Strategies to ensure completion of the full course.

Pharmacological treatment

  • Regimen Choice (Based on Uganda Guidelines 2023 Summary/Dosing Chart - refer to full NTLP guidelines for specifics):
  • - Preferred for PLHIV (>2yrs) & Contacts (>2yrs): 3HP = Rifapentine + Isoniazid once weekly for 3 months.
  • - Preferred for Child Contacts <1yr: 1HP = Rifapentine + Isoniazid once daily for 1 month (only if history of contact with TB case and active TB excluded).
  • - Preferred for Adolescents >13yrs/Adults (Alternative): 1HP = Rifapentine + Isoniazid once daily for 1 month.
  • - Alternative/Commonly Used: 6H = Isoniazid daily for 6 months.
  • - Alternative: 3RH = Rifampicin + Isoniazid daily for 3 months.
  • Co-medication:
  • - Pyridoxine (Vitamin B6) 25mg daily: Co-administer with all Isoniazid-containing TPT regimens to prevent peripheral neuropathy.
  • Dosing: Based on weight bands as per UCG/NTLP dosing chart.
  • Contraindications: Active TB disease, contact of known MDR-TB patient (requires specialist consultation for alternative prevention), severe liver disease, hypersensitivity to TPT drugs.

Monitoring

  • Regular clinical follow-up (e.g., monthly) to:
  • - Assess for and reinforce adherence.
  • - Screen for symptoms of active TB disease.
  • - Monitor for adverse drug reactions (esp. hepatotoxicity - jaundice, nausea/vomiting, abdominal pain; peripheral neuropathy - tingling/numbness).
  • - Routine LFT monitoring usually not required unless baseline liver disease, high alcohol intake, pregnancy, or symptoms develop.

Complications

  • Adverse drug reactions: Isoniazid-induced hepatitis (rare but serious), peripheral neuropathy (preventable with Pyridoxine), rash. Rifapentine/Rifampicin: hepatitis, rash, flu-like syndrome, drug interactions.
  • Development of active TB if screening was inadequate, adherence poor, or infection was already drug-resistant.
  • Development of drug resistance if active TB was missed and treated with inadequate regimen (e.g., INH monotherapy).

Prevention

  • TPT itself is a primary prevention strategy against developing active TB disease in those with latent infection.

Patient education

  • Difference between latent TB infection (sleeping germs) and active TB disease.
  • Purpose of TPT is to prevent active disease.
  • Critical importance of completing the full course of medication for it to be effective.
  • How to take the medication correctly.
  • Potential side effects (especially liver symptoms, nerve symptoms) and the need to report them immediately.
  • Reassurance that TPT does not treat active TB.
  • Importance of attending follow-up appointments.

Uganda-specific notes

TPT targeted primarily at PLHIV and child contacts <5 years, plus other contacts based on programmatic priorities. 3HP is an increasingly preferred shorter regimen. Ensure Pyridoxine is co-prescribed with INH. Active TB exclusion relies heavily on symptom screening. Adherence support is key.

References

  • Uganda Clinical Guidelines (UCG) 2023

    Chapter 5, Section 5.3.2.3, 5.3.2.5 (Dosing Chart)

  • National Guidelines for Programmatic Management of Latent TB Infection (NTLP)

    (Refer to latest NTLP document)

Scroll to Top