People in LMICs are at increased risk of progressing from latent to active TB
Latent TB infection is the reservoir of the TB epidemic. Worldwide, an estimated 1.7 billion people are infected, most living in low- and middle-income countries.
The IMPAACT4TB project will expand access to short-course TB preventative treatment (TPT), (a three-month long regimen known as 3HP and more recently a one-month long regimen known as 1HP), for people living with HIV, children under five years old, pregnant women and household contacts of TB patients. The project seeks to establish 1HP and 3HP as affordable, quality-assured, less-toxic therapies suitable for wide introduction in countries most affected by TB.
“TB infection is the reservoir from which active TB cases develop, which in turn fuels ongoing TB transmission. Scaling up new, safer, shorter TB preventive therapy regimens is essential to contain the reservoir of TB infection and to accelerate progress to ending the TB epidemic.”
Prof Gavin Churchyard, Group CEO, The Aurum Institute.
Progress so far
The first phase of the project achieved a major milestone in generating the missing evidence on short course TB preventative treatment in people with HIV on first line ARVs. This success followed with a fivefold price reductions, improved supply security through bringing two new generics manufacturers to the market, and 3HP roll out at scale in all project countries, with an additional 62 non-project countries following suit. Over 4 million patient courses were procured by partners and countries in 2022, compared to 35,000 in 2017 and the WHO endTB targets for coverage of TB prevention in people living with HIV were overachieved. A costed extension, approved in 2022, is now addressing remaining evidence gaps and catalyzing further scale-up through an innovative donation mechanism to provide 1HP and/or 3HP to seven countries looking to expand uptake of TPT in hard-to-reach populations such as children and household contacts of TB patients. Strong advocacy, community and civil society engagement is an integral part of the intervention and is contributing to establishing the right conditions for faster scale-up in all targeted population groups.
The original IMPAACT4TB project countries were Brazil, Cambodia, Ethiopia, Ghana, India, Indonesia, Kenya, Malawi, Mozambique, South Africa, Tanzania and Zimbabwe, but all have closed except India, Indonesia, Mozambique and South Africa.
The impact we are seeking
The World Health Organization’s End TB Strategy highlights that expanding preventive therapy for TB is essential to achieving the 2030 targets. The IMPAACT4TB investment’s results to date have facilitated the achievement of TPT coverage targets in people living with HIV and is now focused on catalyzing scale-up in household contacts of TB patients, children and pregnant women.
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