This document provides guidelines for programmatic management of tuberculosis preventive treatment in India. It discusses India's high burden of tuberculosis infection and the goal under the National Strategic Plan to provide treatment to 95% of eligible individuals by 2023. The document reviews evidence that tuberculosis preventive treatment reduces risk of developing active TB by 60-90% and is relatively safe. It recommends the 3-month rifampin and isoniazid regimen for individuals ages 0-15 based on evidence of efficacy, safety and improved adherence compared to longer regimens. The document also provides guidance on screening and treatment approaches for high-risk groups like people living with HIV and household contacts of active TB patients.

1. Guidelines for
Programmatic Management of
Tuberculosis Preventive Treatment in India
1
National Workshop for
the Medical College Task Force Members
Kolkata, 22-24 November 2022

2. TB Preventive
Treatment: background,
rational and evidence
Dr. Malik Parmar
National Professional Officer,
DR & Latent TB, WHO-India
2
Acknowledgement: Global TB Programme, WHO HQ (Dr. Avinash Kanchar); NTEP- Nagpur, Mumbai, Dr. Radha Munje

3. National Strategic Plan (2017-25) : Prevent
• The NSP proposes a Detect-Treat-Prevent-Build approach
• Prevention of TB disease by treatment of TBI  critical component of NSP 2017-25
• Strategy –
• “Rigorous, expansive and accountable ‘TB contact tracing and investigation’ for
secondary TB patient detection and treatment coupled with active screening for TB
among HRGs and TPT is one of the key activities under the ‘Prevent’ component of the
NSP.”
• Target –
• “95% of eligible persons provided TPT by 2023”
3

4. Burden of TB infection
4
• India has the highest estimated burden of
tuberculosis infection (TBI) globally,
o with nearly 35-40 crore Indian
population having TBI, of which 26 lakh
(18-36 lakh) are estimated to develop
tuberculosis (TB) disease annually
• National TB Prevalence Survey 2019-21:
o 10,865 (31.6%) were positives for IGRA
o Crude prevalence of TB infection
among population age ≥15years
is 31.3%

5. Review of literature
• 75% of people who develop TB disease after contact with
a patient of active TB are estimated to do so within one
year of TB diagnosis of the index patient and 97% within
two years.
• Molecular fingerprinting studies further confirmed the
probabilities of developing disease within one, two and
five years as 45%, 62% and 83% respectively.
• Risk of developing TB disease after TPT decreases by
approximately 60% and the reduction can be up to 90%
among people living with HIV (PLHIV).
• Epidemiological modelling studies show that effective
implementation of TPT alone in South-East Asia (SEA)
region would result in an annual TB incidence decline of
8.3%, independent of other background interventions.
5

6. Study published in July 2020 from India
• Sample size: 1051 household contact
• 71% household contacts of pulmonary TB (PTB) patients had baseline TBI (tuberculin
skin test [TST] ≥ 5 mm or Quantiferon®- Gold-in-Tube [QGIT] ≥ 0.35 IU/ml).
• Overall, 2% HHC developed incident TB disease (12 cases/1000 person-years, 95%CI:
8–19)
oHIV infection (aIRR = 29.08, 95% CI: 2.38–355.77, p = 0.01) and undernutrition
(aIRR = 6.16, 95% CI: 1.89–20.03, p = 0.003) were independently associated with
incident TB disease while
oage, diabetes mellitus, smoking, alcohol, and baseline TBI, regardless of TST (≥ 5
mm, ≥ 10 mm, ≥ 6 mm increase) or QGIT (≥ 0.35 IU/ml, ≥ 0.7 IU/ml) cut-offs
were not associated.
6
Source: Paradkar M, Padmapriyadarsini C, Jain D, Shivakumar SVBY, Thiruvengadam K, Gupte AN, et al. (2020) Tuberculosis preventive treatment should be
considered for all household contacts of pulmonary tuberculosis patients in India. PLoS ONE 15(7): e0236743. https://doi.org/10.1371/journal.pone.0236743

7. TPT works
7
Efficacy
• Current TPT provides
risk reduction of 60-
90% between those
who get TPT versus
those who do not
• Protection lasts
between 6 to 19 years
with IPT.
Safety
• a very small proportion
of people on TPT
develop serious adverse
events
• most adverse events are
self-limiting and
reversible
• shorter rifamycin-based
regimens have a better
safety profile
Risk of drug resistance
• No evidence to date
showing increased
resistance due to
PMTPT

8. Protection with TPT last for 6 to 19 years
IPT reduced TB
incidence in
Alaska Natives
• substantially in
1950s
(extremely high
TB rates, more
than Southern
Africa at peak)
protective
effect 19 years
In Brazil (Thrio
study),
• 6H in TST +
PLHIV reduces
TB risk over 7
years
Temprano ANRS
12136 trial,
• Côte d’Ivoire
(159 per 100
000) 6H,
sustained
benefits up to 6
years
Recent studies
from Myanmar
and Indonesia,
• protective
effect with IPT
5-8 years
Brief-TB
• high TB burden
countries,
PLHIV on ART -
3HP protection
as durable as
Isoniazid
8

9. Cascade of TB case finding and TPT
• The aim is to have significant
impact on an individual’s
health as well as to reduce TB
burden and transmission.
• In the cascade of care
approach,
o Reach out to all target
population who are at-risk
of developing TB disease
o Screened for TB disease and
o Provide TPT after ruling out
TB disease
9
Target Population
Rule out active TB
Presumptive TB
No signs/
symptoms of TB
Active TB ruled
out
Test for TB infection
(as per policy)
TB confirmed
Evaluate for TPT
Start TB
treatment
Systematic follow-up
Systematic follow-up
Start TPT

10. # 3-months daily Rifampicin and Isoniazid (3RH) TPT regimen is introduced in 0-15 years individuals in 6 states
* Prioritizing pulmonary bacteriologically confirmed TB
Target population Strategy Treatment Options#
 People living with HIV (+ ART)
o Adults and children >12 months
o Infants <12 months with HIV in contact with active TB
 HHC below 5 years of pulmonary* TB
TPT to all after
ruling out
active TB
disease
6-months daily
isoniazid (6H) or
3-months weekly
Isoniazid and
Rifapentine (3HP) in
persons older than 2
years
 HHC 5 years and above of pulmonary* TB
Testing for TBI
and TPT after
ruling out TB
disease
 Other risk group
o Person initiating Immuno-suppressant or Anti-TNF treatment; Silicosis;
Person on dialysis; Transplant recipient
o Malnourished, diabetes, alcohol abuse, smoker and integration with ACF
• HHC of DR-TB patients
o HHC of MDR-TB patients (FQ susceptible)
o HHC of H-mono/poly patients (R susceptible)
6-months daily
levofloxacin (6Lfx)
4-months daily
Rifampicin (4R)
National TPT policy
10
10

11. Evidences for 3HP… 1
• No significant difference in the incidence of active TB between participants given a 3HP and
6H or 9H (RR 0.73, 95% CI 0.23; 2.30). The risk for hepatotoxicity was significantly lower with
3HP in adult PLHIV (RR 0.26, 95% CI 0.12; 0.55) and in those without HIV (RR 0.16, 95% CI
0.10; 0.27) (Martinson NA et al., Sterling TR et al.)
• The 3HP regimen was also associated with a higher completion rate in all subgroups (adults
with HIV: RR 1.25, 95% CI 1.01; 1.55; adults without HIV: RR 1.19, 95% CI 1.16; 1.22; children
and adolescents: RR 1.09, 95% CI 1.03; 1.15) (https://apps.who.int/iris/handle/10665/260233)
• Compared to 9H, it was observed that the 3HP has a better completion rate in a multicentre
randomized controlled study in Taiwan (Sterling TR et al. and Sun HY et al)
• Systematic review of adverse events of rifapentine and isoniazid compared to other
treatments for latent tuberculosis infection (23 RCTs & 55 non-randomised studies) shows
lower rate of AEs with 3HP (Peace C et al.)
11

12. Evidences for 3HP… 2
• No significant difference in TB incidence was found in an intention-to-treat analysis;
however, a per-protocol analysis showed a lower rate of TB infection or death in participants
given continuous isoniazid. In all the studies, 3HP was given under direct observation (WHO
consolidated guidelines on tuberculosis. Module 1: prevention – tuberculosis preventive treatment)
• In a study of 3HP in 112 pregnant women, the rates of spontaneous abortion and birth
defects were similar to those in the general population in the US (Moro RN et al)
• The clear advantages of these regimens are better adherence due to the shorter duration
and fewer adverse events. The use of shorter rifamycin-based regimens is associated with at
least 20% greater treatment completion rate (82% vs 61%). WHO recently assessed and
recommended several shorter rifamycin-based regimens as alternatives to six months of
isoniazid (Alsdurf H et al.)
12

13. Prevalence of TB infection and initiation of TPT (2019-21)
13
4647 (46%) persons
provided TPT
• 82% provided 6H
• 18% provided 3HP
71% TPT
completion rate
• 66% completion
rate -6H
• 94% completion
rate -3HP

14. Evidences for 3RH
 A systematic review updated in 2017  efficacy and safety profile of 3RH were
comparable with 6H.
 Another review of 3RH effectiveness compared with isoniazid for 6 or 9 months in children
identified one RCT and two observational studies 
o Less number of individuals receiving 3RH developed radiographic changes than those given 9
months of isoniazid (RR 0.49, 95% CI 0.32; 0.76).
o Also reported lower risk for adverse events (RR 0.33, 95% CI 0.20; 0.56) and higher adherence
rate (RR 1.07, 95% CI 1.01; 1.14) among children given 3RH
o Similar findings were reported in the observational studies.
Stagg HR, Zenner D, Harris RJ, Muñoz L, Lipman MC, Abubakar I. Treatment of Latent Tuberculosis Infection. Ann Intern Med. 2014 Sep 16;161(6):419–28.
Spyridis NP, Spyridis PG, Gelesme A, Sypsa V, Valianatou M, Metsou F, et al. The effectiveness of a 9-month regimen of isoniazid alone versus 3- and 4-month
regimens of isoniazid plus rifampin for treatment of latent tuberculosis infection in children: results of an 11-year randomized study. Clin Infect Dis. 2007
Sep 15;45(6):715–22.
14

15. 5018 HHC 5-15 years since November 2020
4767 screened for TB
4364 (91.4%) underwent IGRA
22 (0.4%) Active TB
700 (84.6%) initiated 3RH
4745 (99.6%) eligible for IGRA
127 (15.4%) HHC pending
decision of District
Pediatric Committee
103 (14.7%) currently on Rx
3-months Rifampicin and
Isoniazid (3RH) TPT regimen
in HHC >/=5years – 1 State
Similar experience of
3RH TPT regimen in HHC
<5years
Outcome (# 597)
• 587 (97.8%) Rx Completed
• 10 (1.7%) Lost to follow up
• 3 (0.5%) Stopped Rx d/t ADR
• Treatment failure=0
827 (18.9%) IGRA +ve

16. TPT reduces mortality independent of ART
16
Badje et al, CROI 2017
Long term follow-up of
TEMPRANO
show 37% reduction in
TB mortality in PLHIV with
high CD4 counts, receiving 6
months of IPT,
independent of ART

17. TPT eliminates TB risk among PLHIV along with ART
17
Studies IPT alone ART alone ART plus IPT
Brazil 68 52 80
South Africa 13 64 89
Botswana 65 67 97
TB risk reduction
AIDS 2007: 21: 1441-8;
AIDS 2009, 23:631–636;
Lancet 2011: 377:1588-98
Greater TB risk reduction with combined
ART and IPT

18. TPT is relatively safe (systematic review 2018)
• 23 RCTs & 55 non-randomised studies
• Rate of any AE: 3HP (11.5%), 3-4R (20%), 6H (36.1%), 9H (17.6%)
• Withdrawals due to AEs: 3HP (1.7%) vs 9H (6.4%), 6H (3.8%)
• Flu like reactions: 3HP (2.2%) vs INH (0,05%)
• Hepatotoxicity: 3HP (1%), 3-4R (0.01%), 6H(6.3%), 9H (3.1%)
18
A systematic review of adverse events of rifapentine and isoniazid compared to other treatments for latent tuberculosis infection:
Christopher Pease, et.al.,Pharmacoepidemilology and drug safety, Volume 27, Issue 6, 2018

19. No increase in risk of resistance
with rifamycin based TPT-(1)
• Systematic review in 2016: 6 RCTs of rifamycin based TPT vs active control or
placebo included
• Only 6 (0.09%) rifampicin resistant cases in 6808 individuals receiving rifamycin
based TPT
• 1 (0.01%) rifampicin resistant case among 7415 individuals receiving
alternative regimens
• RR = 3.45, (95%CI 0.72–16.56; P = 0.12)
19

20. No increase in risk of resistance
with Intermittent rifamycin
• In 3 studies of intermittent rifamycin based TPT there were
• 3 cases of rifampicin resistance in 4673 individuals on rifamycin-containing
regimens
• 1 cases with rifampicin resistance in 4427 in control regimens
• RR = 3.89, (95%CI 0.44–34.56; P = 0.22).
20

21. No increase in risk of resistance
with Isoniazid
21
• RR of resistance 1.45
(95% CI 0.85 – 2.47)
• Similar results when stratified by
HIV
(Balcells ME, Emerging Infectious Diseases, 2006)
Systematic review in 2006 of published data since 1951, 13 studies, IPT =
18095, controls = 17,985

22.  Absence of any TB symptom
 Absence of any chest
radiography abnormality
HIV negative contacts aged ≥ 5 years
22
Chest radiography should not be considered barrier for starting TPT

23. PLHIV on ART
23
Chest radiography may be offered to PLHIV on ART and TPT given to those with
no abnormal radiographic findings
Chest radiography should not be considered barrier for starting TPT

24. FAQ – TPT in pregnant woman
24
• Pregnancy does not disqualify women living with HIV
• TPT can be started either antenatal and postnatal
periods with due clinical care
• Routine LFT not indicated unless there are other
hazards
• 4R, 3HP, triple pill combination of 6(H+
Cotrimoxazole+ B6) may be preferred TPT options
• Vitamin B6 supplementation should be given
routinely to pregnant and breastfeeding women on
TPT
Systematic review for the 2020
WHO guidelines showed
• No association of IPT with
adverse pregnancy outcomes
(foetal/neonatal death,
prematurity, LBW, congenital
anomaly) across different
studies
• No increase in risks for
maternal hepatotoxicity,
grade 3 or 4 events or death
• deferral of TPT to postpartum
period not required

25. FAQ – Repeat or restart TPT
25
• No evidence to date on
the utility of repeated
courses of TPT
• In high TB transmission
settings, WHO
recommends 36 H (proxy
for life long) for PLHIV
WHIP3TB trial among PLHIV on ART (2019), compared
effectiveness of 3HP given once (N=1802) or twice within 14
months (N=1808) Vs one course of 6H (N=404).
• Treatment completion was better with 3HP
• 24 months follow-up showed similar rates of incidence of
TB, rifampicin resistant TB and mortality between those
receiving 3HP once or twice
A repeat course of TPT may be considered among HIV+ or HIV- persons following fresh
exposure to infectious TB patient- clinical judgement
The recommendation is considered in NTEP and soon issue guidance

26. FAQ - TPT after TB treatment
26
All children living with HIV who have successfully completed treatment for
TB disease may receive TB preventive treatment.
(Conditional recommendation, low certainty in the estimates of effect)
PLHIV face higher risk of recurrence following TB treatment compared to HIV-negatives
due to higher treatment failure, emergence of DR-TB or reinfection (In a study among
PLHIV cured of TB, 14% experienced recurrence and about 90% of them with a different
strain).
TPT may be considered following a complete course of TB treatment among
PLHIV when new TB exposure is confirmed e.g. contact of a bacteriologically
confirmed TB patients)- clinical judgement
Under NTEP, post-TB-treatment is considering presently in PLHIV only

27. Co-administration of 3HP and Dolutegravir
• DOLPHIN trial (Dolutegravir Rifapentine Isoniazid Investigation) reported no
serious adverse events
• Although co-administration caused reduced DTG blood levels, this was clinically
not significant and did not require DTG dose adjustment.
27

28. Additional other risk group for TPT
• WHO Operational handbook on TB: Module 1 – TPT (2020)
• Systematic LTBI testing and treatment may be considered for prisoners, health workers,
immigrants from countries with a high TB burden, homeless people and people who use
drugs.
• National programmes implementing ACF among at-risk populations should consider
integration of TPT services within the package of care to increase coverage with minimal
additional investment, and vice versa programmes implementing TPT should link eligible
individuals to services for TB disease diagnosis and treatment.
28

29. Community screening and TPT to eligible
• WHO Consolidated guidelines on TB: Module 2 – Systematic screening for TB
• Systematic screening for TB disease may be conducted among the general population in
areas with an estimated TB prevalence of 0.5% or higher (updated recommendation:
conditional recommendation, low certainty of evidence).
• References:
• Vietnam with estimated prevalence of 0.35% for 3 years annual community screening
• China conducted door-to-door symptom screening followed by CXR between 2012 and 2015;
reduction in absolute number of patient with TB disease
29

30. ACF – vulnerable groups for TB
30
Clinical Social Geographical
Clients attending HIV Care Settings Prisoners Urban Slums
Substance abuse including smokers Occupations with
risk of developing TB
Hard to reach
areas
Co-morbidities like Diabetes Mellitus,
Malignancies, patients on dialysis and on long
term immunosuppressant therapy
People in
Congregated
settings – night
shelters, Immigrants
De-addiction
centres, Old age
homes
Indigenous and
tribal
populations
Health Care Workers
Household & Workplace Contacts
Patients with Past History of TB
Malnourished
Antenatal mothers attending antenatal
clinics/MCH clinics
• Blue: Current
policy
• Green: Flexibility
to State TPT
committee and
now expecting
national policy
• Red: Proposal of
test and treat
with TPT in
vulnerable
population
during ACF

31. Recommendation of NTEG – 17 Aug ‘22
• Recommended CTD to introduce Cy-Tb skin test and provide 3HP under programme;
estimated procurement of 104.34 lakh TBI test (Cy-Tb) and 100.32 lakh TPT course
(3HP) for 2 years
• Monitoring of the Ni-kshay TPT data - coverage, follow-up, breakdown rate and
adverse event; making available Nikshay TPT dashboard.
• Collaborate with NACP for analysing the data of TPT put on on >10 lakh PLHIV
• Collaboration with other programme for TPT policy inclusion for bi-directional
screening among high-risk groups for TB infection/disease
• TPT among high-risk groups during periodic ACF activities and community level
interventions in limited geographies for gaining programmatic experience and further
expansion
• Development of targeted communication materials
31

32. Systematic review & meta-analysis
• Reduced risk of TB incidence with
treatment for MDR-TBI, suggesting
effectiveness in prevention of
progression to MDR-TB, and confirmed
cost-effectiveness.
• Estimated MDR-TB incidence
reduction was 90% from 5 studies
• High treatment discontinuation rates
due to adverse effects in persons
taking pyrazinamide-containing
regimens.
• Cost-effectiveness was greatest using a
fluoroquinolone/ethambutol
combination regimen.
32
Rationale for TPT in DR-TB contacts
• Mathematical modelling suggests 3 in every 1000
people globally carry MDR-TB infection and
• Prevalence of MDR-TB in those with TBI is more than
double among those younger than 15 years.
• HHC of patients with MDR/RR-TB or H mono/poly DR-
TB are at higher risk of TB infection than contacts
exposed to DS-TB. However, risk of progression to TB
disease does not differ among contacts in both
groups.
• Concern of higher resistance when treating with daily
4R in contacts of H resistant R sensitive DR-TB is not
supported by any scientific evidence till the time

33. • 6Lfx vs placebo
• In infants & <5 years
of age exposed to
MDR-TB
TB
CHAMP
• 24 week of Lfx vs
placebo
• In all ages with
evidence of infection
V-QUIN
• 26 week of Dlm vs H
• In all ages
PHOENIX
33
WHO recommendation and studies
• WHO recommends TPT among contacts exposed to MDR-TB
with FQ sensitive or H resistant with R sensitive DR-TB
patients following…
o Consideration of intensity of exposure;
o Confirming the source patient and her/his DR-TB pattern
o Ascertaining TB infection using IGRA or TST
• 6Lfx among contacts exposed to patients with known MDR-
TB with FQ sensitive
• 6H among contact of H susceptible in confirmed RR-TB index
patient
• 4R among contacts with known Hr-TB with R sensitive
• Clinical follow up for 2 years regardless of treatment
• Any emergent signs and symptoms suggestive of TB should
be actively investigated and regimen started as needed.
Studies in pipeline

34. Challenge while following up
TPT cascade of care
• Globally, there are significant
losses in the cascade of care
prior to initiation of PMTPT, in
addition to patient non-
adherence following initiation
of treatment.
• Research studies from all over
the world show that among
those estimated to be eligible
for PMTPT, less than 20%
completed the entire cascade
of care
34

35. Prevalence of TB infection (TBI) and TPT among household contacts of TB
Patients in Mumbai (Unpublished – CTO Mumbai)
[CELLRANGE], 8
[CELLRANGE], 8
[CELLRANGE], 76
[CELLRANGE], 502
[CELLRANGE], 502
[CELLRANGE], 502
[CELLRANGE], 273
[CELLRANGE], 254
[CELLRANGE], 215
[CELLRANGE], 194
0
100
200
300
400
500
600
Initiated on TB
Tx
TB Diagnosed TB Evaluated Symptom
screened for TB
Enrolled HHCs IGRA tested IGRA positive LTBI TPT initiated TPT completion
TBI
TPT cascade
TB cascade
62,
82%
2, 3%
10,
13%
1, 1%
1, 1%
TB diagnostic test (n=76)
CBNAAT
CT Scan
Smear
TRUNAAT
Clinical
evaluation
Refusal 29
Out of Mumbai 6
Severe skin disease 1
Chronic alcoholic 1
Other reasons 2
11 HHCs TB
evaluation is
incomplete
8 Diagnosed &
put on DSTB Tx
1. 194/215 ( 90% ) treatment completion
2. Total 21/215 ( 10 % ) discontinued TPT of which 3% discontinued due to ADRs

36. LTBI and TB
care cascade
Total HHC refused to consent – 189 (15%)
Total HHC consented but refused IGRA – 77 (7%)
HHC refused for CXR – 78 (16%)
HHC refused for
TPT – 61 (16%)
Rejected samples: 9 (1%) due to
Hemolysis/spillage
HHC diagnosed with TB – 8 (0.7%)
Processed samples for IGRA-1030 (99%)
Consented for screening – 1116 (85%)
Samples collected for IGRA – 1039 (93%)
IGRA Positive HHCs – 459 (45%)
HHCs with CXR – 381 (84%)
HHCs initiated TPT – 320 (83%)
HHCs completed TPT – 271 (85%)
Eligible for screening - 1305
HHCs discontinued TPT- 31 (9%)
Household Contact Active And Latent Tuberculosis Intervention (HAALT)
Nagpur, India [Unpublished – Dr. Radha Munje]

37. Thank you!!
37

38. Enumeration, ruling out
active TB, testing for TBI,
TPT initiation and ADR
Dr. Ravinder Kumar
Specialist- TB,
Central TB Division, New Delhi
38

39. Definitions of contacts and contact investigation
• Contact. Is any individual who is exposed to a person with active TB disease.
• Close contact. Is a person who is not in the household but shares an enclosed space, such as at a
social gathering, workplace or facility, for extended periods during the day with the index TB patient
during the three months before commencement of the current TB treatment episode. This group will
be included for all interventions as applicable for household contacts in these guidelines.
• Household contact (HHC). Is a person who shared the same enclosed living space as the index TB
patient for one or more nights or for frequent or extended daytime periods during the three months
before the start of current TB treatment. [For simplicity, close contacts may be considered inclusive
in this term throughout the guidelines.]
• Contact investigation. Is a systematic process for identifying previously undiagnosed people with TB
disease and TB infection among contacts of an index TB patient and/or other comparable settings
where transmission occurs. [Contact investigation consists of identification, clinical evaluation and/or
testing and provision of appropriate anti-TB treatment (for people with confirmed with TB) or TB
preventive treatment (for those without TB disease)].
39

40. Identifying at-risk population
• Some countries like Vietnam are contemplating community-wide screening at
frequent intervals and population level TPT provision
• However, a targeted approach is considered as an appropriate public health
response, currently. Reason-
o not all individuals infected with M. tuberculosis develop active TB disease
o no predictive tests to identify individuals who will progress to disease
• TPT is a continuum of care for routine programme activities including ACF.
o Active TB case finding (ACF) process also offers an opportunity to simultaneously rule
out active TB among HRG and identify the target population for TPT, wherein PMTPT
services can be integrated within existing ACF interventions.
40

41. * Prioritizing pulmonary bacteriologically confirmed TB
# 3-months daily Rifampicin and Isoniazid (3RH) TPT regimen is introduced in 0-15 years individuals in 6 states
Target population Strategy Treatment Options#
 People living with HIV (+ ART)
o Adults and children >12 months
o Infants <12 months with HIV in contact with active TB
 HHC below 5 years of pulmonary* TB
TPT to all after
ruling out
active TB
disease
6-months daily
isoniazid (6H) or
3-months weekly
Isoniazid and
Rifapentine (3HP) in
persons older than 2
years
 HHC 5 years and above of pulmonary* TB
Testing for TBI
and TPT after
ruling out TB
disease
 Other risk group
o Person initiating Immuno-suppressant or Anti-TNF treatment; Silicosis;
Person on dialysis; Transplant recipient
o Malnourished, diabetes, alcohol abuse, smoker and integration with ACF
• HHC of DR-TB patients
o HHC of MDR-TB patients (FQ susceptible)
o HHC of H-mono/poly patients (R susceptible)
6-months daily
levofloxacin (6Lfx)
4-months daily
Rifampicin (4R)
TPT target group, strategy and regimen options
41
41

42. Options of tests for TB infection
42
TST IGRA C-Tb
Sensitivity High High High
Specificity Low in BCG vaccinated High even in BCG vaccinated High even in BCG vaccinated
Ease of use Field friendly, complex test
interpretation
Requires lab and infrastructure Field friendly, single cut-off
allows simple test interpretation
Cost of test Low High Low
Manufacturing Complex, old products Complex, multiple components Robust with high yield, well
defined and completely
characterised
Special populations
Children Affected by young age Affected by young age More robust
PLHIV Requires info on HIV status Affected by HIV and low CD4
count
More robust with low CD4
 PLHIV and Household Contacts < 5years old are offered TPT directly without testing

43. 1. If <10 years, any one of current cough or fever or history of contact
with TB or reported weight loss or confirmed weight loss >5% since
last visit or growth curve flattening or weight for age <-2 Z-scores.
Asymptomatic infants <1 year with HIV are only treated for TBI if
they are household contacts of TB. TST or IGRA may identify PLHIV
who will benefit most from preventive treatment. Chest radiography
(CXR) may be used in PLHIV on ART, before starting TPT.
2. Any one of cough or fever or night sweats or haemoptysis or weight
loss or chest pain or shortness of breath or fatigue. In children <5
years, they should also be free of anorexia, failure to thrive, not
eating well, decreased activity or playfulness to be considered
asymptomatic.
3. Including silicosis, dialysis, anti-TNF agent treatment, preparation for
transplantation or other vulnerable risk groups where testing must
precede before TPT.
4. Including acute or chronic hepatitis; peripheral neuropathy (if
isoniazid is used); regular and heavy alcohol consumption. Pregnancy
or a previous history of TB are not contraindications.
5. Regimen chosen based on considerations of age, strain (drug
susceptible or otherwise), risk of toxicity, availability and preferences.
6. CXR may have been carried out earlier as part of intensified case
finding.
Algorithm for TB screening and TPT
43
43
NO
Defer preventive
treatment
YES
Give preventive
treatment5
NO
NO
<5 years
TST or IGRA
Symptomatic?2
Investigate for active TB
Follow-up for active TB as necessary, even for patients who have completed preventive treatment
YES
Abnormal
YES
Positive or unavailable Negative
Preventive treatment
contraindicated?4
No active TB
Normal or
unavailable
5 years +
CXR6
Any symptom1 of
current cough or fever or
weight loss or night sweats
Household contact
HIV positive Other risk group 3
<5 years
Preventive treatment
contraindicated?4
No active TB
Give preventive
treatment5
NO
Preventive treatment
contraindicated?4
No active TB

44. Implementation consideration
Tuberculin skin test (TST)
• Ensure availability and supply of tuberculin in cold chain, syringes, needles
and consumables
• Train health personnel
• Ongoing capacity building and supportive supervision
• Develop mechanisms to ensure standardized application of test procedures,
mentoring and supervision and periodic standardized reliability testing for
quality assurance.
• Establish mechanisms to call people who have been tested to return for the
test reading within 48–72 hours of tuberculin administration, or alternatively
ensure test reading at the person’s residence.
44

45. Implementation consideration
Interferon-Gamma Release Assay (IGRA)
• Develop capacity of the laboratory system and technicians (phlebotomy, incubation and
reading)
• Rapid transportation of blood specimens (within 8–30 hours to allow incubation)
• Regular maintenance of lab equipment
• Map out IGRA testing facilities available both in public and private sector in the state.
• Biggest potential for expansion of IGRA testing across India may be in collaboration with
private lab
• Opportunity for funding request through the national health mission (NHM) using
established mechanisms of annual project implementation planning (PIP).
45

46. Enumerating target population
• First and most critical step for universal access and success of PMTPT
• The complete list of PLHIV, HHC and other risk groups need to be available on a
weekly basis with the concerned health-care provider at health facility (HF)
(including health & wellness cenre [HWC] & private providers [PPs]), TB Units (TU),
integrated counselling and testing centres (ICTC) and anti-retroviral treatment (ART)
centres and those health facility providers caring for other risk groups.
46

47. Active case finding rounds
• ACF rounds are an add-on to complement the contact tracing.
• Mapping of target populations must be an integral part of the vulnerability mapping for ACF
activity
• Enumeration in Ni-kshay
o Vulnerable groups considered for TPT in the state
o the HHC of pulmonary* TB patients detected during ACF rounds.
47

48. Contraindications of TPT
• Active TB disease (absolute)
• Acute or chronic hepatitis
• Concurrent use of other hepatotoxic medications (such as nevirapine)
• Regular and heavy alcohol consumption
• Signs and symptoms of peripheral neuropathy like persistent tingling, numbness and
burning sensation in the limbs
• Allergy or known hypersensitivity to any drugs being considered for TPT
48

49. Counselling of eligible person and family
Need to share transparent information with the eligible person and family-
• information on TBI,
• need for TPT,
• schedule of medication,
• Adherence support and follow-up visits,
• benefits from completing the course,
• adverse events,
• actions on development of TB symptoms
49
NTEP national call center (NIKSHAY
SAMPARK – Toll free number
1800116666) should be made available
to the index TB patients, family
member and TPT beneficiaries

50. Pre-TPT assessment
Personal history
• Elicit relevant info.
• allergy or known
hypersensitivity to TB
drugs (isoniazid,
rifampicin, rifabutin or
rifapentine).
• HIV status and ART
regimen;
• pregnancy or family
planning
• assess presence of co-
morbidities
History of
medication
• certain drug classes
• ARVs, opioids,
antimalarials – often
affect TPT.
Liver function test
(LFT)
• not a mandatory
• baseline testing in
individuals with risk
• having abnormal
baseline LFT results
(ALT/AST is ≥ 3 times
upper limit of normal
[ULN] in the presence of
symptoms or ≥ 5 times
the ULN in the absence
of symptoms), clinical
judgement is required
Social and
financial situation
• assessment to
overcome the barriers
for TPT completion.
50

51. Comparison of TPT options
6H 3HP 3RH
Medicines Isoniazid Isoniazid + rifapentine Isoniazid + Rifampicin
Duration (months) 6 3 3 months
Interval Daily Weekly Daily
Doses 180 12 84
Pill burden per dose
(total no. of pills for an
average adult)
1 (180 pills) 9 pills with loose drugs
(108 pills)
3 pills of FDC (36 pills)
3 (252 pills)
Pregnant women Safe for use Not known Safe for use
Interaction with ART No restriction Contraindicated:
All PIs, NVP/NNRTIs, TAF
Use: Tenofovir,
Efavirenzes (600 mg),
DTG, RAL (without dose
adjustment)
Contraindicated: All PIs,
NVP/most NNRTIs@
Use with caution: Tenofovir
Adjust dose: Raltegravir,
Dolutegravir
Use: TDF, EFV (600 mg) 51

52. Dosage of 6H regimen
Regimen Dose by age and weight band
6 months of daily
isoniazid
monotherapy (6H)
Age 10 years & older: 5 mg/kg/dayd
Age <10 years: 10 mg/kg/day (range, 7–15 mg)
d Maximum dose of H if given daily would be 300 mg/day
52

53. Dosage of 3HP regimen
Regimen Dose by age and weight band
Three months of
weekly rifapentine
plus isoniazid (12
doses) (3HP)
Age 2-14 yearsc
Medicine, formulation 10–15 kg 16–23 kg 24–30 kg 31–34 kg >34 kg
Isoniazid, 100 mga 3 5 6 7 7
Rifapentine, 150 mg 2 3 4 5 5
Isoniazid + rifapentine
FDC (150 mg/150 mg)d
2 3 4 5 5
Age >14 yearsc
Medicine, formulation 30–35 kg 36–45 kg 46–55 kg 56–70 kg >70 kg
Isoniazid, 300 mg 3 3 3 3 3
Rifapentine, 150 mg 6 6 6 6 6
Isoniazid + rifapentine
FDC (300 mg/300 mg)b
3 3 3 3 3
a 300 mg formulation can be used to reduce the pill burden
b Expected to become available in the near future
53

54. Dosage of 3RH regimen
54
Regimen Dose by age and weight band
3RH – three months of
daily rifampicin and
isoniazid
Isoniazid:
Age 10 years & older: 5 mg/kg/dayd
Age <10 years: 10 mg/kg/day (range, 7–15 mg)
Rifampicin:
Age 10 years & older: 10 mg/kg/day
Age <10 years: 15 mg/kg/day (range, 10–20 mg)
Weight band
d Maximum dose of H if given daily would be 300 mg/day
Weight
band
4-7 kg 8-11 kg 12-15 kg 16-24 kg ≥25 kg
RH 75/50
mg (FDC)
1 2 3 4
Use adult
formulation

55. Post-treatment TPT for PLHIV
• all CLHIV/PLHIV who had successfully completed treatment for TB disease earlier
should receive a course of TPT after completing treatment of TB.
o 5-7 times higher risk of recurrence of TB among PLHIV and nearly 90% of these due to
re-infection.
o Ensure completion of the initial course of TB treatment and effective infection control
measures in clinical and community settings would reduce recurrence of TB.
55

56. Role of pyridoxine and its availability
• Peripheral neuropathy  secondary to a deficiency of vitamin B6
(pyridoxine)
o commonly during TB treatment and infrequently with standard
doses of H for TPT
o recognized as symmetrical numbness and tingling of the
extremities
o usually easily reversible upon withdrawal of H and giving high-
dose pyridoxine therapeutic dose (100–200mg/day).
• Dose: 10 mg/day in children and 25 mg/day in adults. 50 mg/day in
adult PLHIV.
• TPT should not be withheld if pyridoxine is not available.
56
Recommended group for
pyridoxine prophylaxis when
on Isoniazid based regimen:
• malnutrition,
• chronic alcohol
dependence,
• HIV infection,
• renal failure
• diabetes,
• pregnant or breastfeeding

57. Possible adverse event
associated with TPT drugs
57
Drug Known adverse events Rare adverse events
Isoniazid
 Asymptomatic elevation of serum liver enzyme concentrations
 Hepatitis
 Peripheral neuropathy (paraesthesia, numbness and limb pain)
 Skin rash
 Sleepiness and lethargy
 Convulsions
 Pellagra
 Arthralgia
 Anaemia
 Lupoid reactions
Rifampicin
 Gastrointestinal reactions (abdominal pain, nausea, vomiting)
 Hepatitis
 Generalized cutaneous reactions
 Thrombocytopenic purpura
 Discoloration of body fluids
 Osteomalacia
 Pseudomembranous colitis
 Pseudoadrenal crisis
 Acute renal failure
 Shock
 Haemolytic anaemia
 Flu-like syndrome
Rifapentine
 Gastrointestinal reactions (abdominal pain, nausea, vomiting)
 Hypersensitivity reactions (flu-like symptoms)
 Hepatitis
 Discoloration of body fluids
 Hypotension/syncope
 Decrease in white blood cell and red
blood cell count
 Decreased appetite
 Hyperbilirubinemia

58. Women and TPT
• Pregnancy should not disqualify women living with or without HIV for TPT
• TPT can be started during antenatal and postnatal periods taking due care.
• Isoniazid and Rifampicin, are considered safe for use in pregnancy.
oPyridoxine (Vitamin B6) supplementation should be given routinely to all
pregnant and breastfeeding women on TPT.
• There is limited data on the efficacy and safety of rifapentine in pregnancy
58

59. Contraception and TPT
• Rifampicin and Rifapentine interact with oral and hormonal contraceptive 
• risk of decreased contraceptive efficacy.
• use an alternative (such as depot medroxyprogesterone acetate (DMPA) every
eighth week or higher dose oestrogen (50μ)) in consultation with a clinician;
• or use another form of contraception, a barrier contraceptive or intra-uterine
device.
• In women having hormonal contraceptive implants, the interval for replacing the
implants may need to be shortened from 12 weeks to eight weeks.
59

60. Liver disease and TPT
• Isoniazid and rifampicin/rifapentine are associated with liver damage.
• baseline liver transaminase values >3 times UNL  initiation of TPT with
caution
• End-stage liver disease  defer TPT
• Acute hepatitis (including acute viral hepatitis)  defer TPT until the acute
hepatitis has resolved.
• 6H is well-tolerated with chronic hepatitis B virus (HBV) or hepatitis C virus
(HCV) infections.
• People with HCV infection should consult with their health-care providers and
start rifamycin-based TPT either before or after completing treatment for HCV.
60

61. Renal Failure & TPT
• Isoniazid and rifampicin/rifapentine are eliminated by biliary excretion.
• Thus, TPT can be given in standard dosages to individuals with renal failure.
• Persons with severe renal failure should receive isoniazid with pyridoxine (vitamin B6) to
prevent peripheral neuropathy.
61

62. People living with HIV and TPT
• Challenge in TPT with rifamycin-based regimen among PLHIV  drug–drug
interaction.
oRifampicin and rifapentine can be co-administered with efavirenz without dose
adjustment,
oPLHIV receiving raltegravir and rifampicin, a higher dosage of raltegravir (800 mg
twice daily) should be used.
oRifampicin or rifapentine TPT regimens should not be co-administered with
protease inhibitors (atazanavir/ ritonavir, lopinavir /ritonavir) or nevirapine.
62

63. Babies born to mothers with
TB disease and TPT
• If a newborn is not well  refer him/her to a specialist/pediatrician.
• If the newborn is well (absence of any signs or symptoms presumptive of TB) TPT
must be provided.
• Experts in India recommend that the Bacille Calmette-Guérin (BCG) vaccination
should not be delayed even if TPT is administered.
• It is advised to administer pyridoxine at 5–10 mg/day.
• If the infant is HIV-exposed (mother is HIV infected) and on nevirapine  start 6H
• TPT with rifamycin based regimen cannot be given along with nevirapine prophylaxis
• If the mother is taking anti-TB drugs continue to breastfeed with appropriate
practice like using a mask and cough etiquette.
63

64. TPT among people who use drugs
• People who use drugs (PWUD) have a higher prevalence of TBI and incidence of TB disease.
• People taking rifamycin based regimen with OST should be closely monitored for signs of
opiate withdrawal and other adverse events.
o Rifapentine has not been systematically studied among people who use drugs. However,
rifampicin is known to reduce exposure to opioid substitution therapies (OST) such as
methadone and buprenorphine. In some people, this results in opiate withdrawal.
o Increasing the dose of methadone or buprenorphine when taking rifamycins can lessen the risk
of withdrawal.
• 6H is safe to use among PWUD careful monitoring for liver toxicity is important.
• Drug use should never be taken as a blanket rationale for denying someone TPT.
• It is the responsibility of health-care providers to proactively manage drug–drug interactions
for PWUD safely.
64

65. TPT in DR-TB Contacts
65
• 6Lfx (6 months of daily levofloxacin)
Contact of MDR/RR-TB
(FQ susceptible)
• 4R (4 months of daily rifampicin)
Contact of Hr-TB (R
susceptible)

66. TPT regimen and dosages for
Contacts of DR-TB index patients
66
Regimen Dose by age and weight band
Six months of daily levofloxacin
(6Lfx) for contacts of R resistant
FQ sensitive patients#
Age > 14 years, by body weight: < 45 kg, 750 mg/day; ≥ 45 kg, 1g/day
Age < 15 years (range approx. 15–20 mg/kg/day), by body weight:
5–9 kg: 150 mg/day
10–15 kg: 200–300mg/day
16–23 kg: 300–400mg/day
24–34 kg: 500–750mg/day
Four months of rifampicin daily
(4R) for contacts of H resistant R
sensitive patients*
Age 10 years & older: 10 mg/kg/day@
Age <10 years: 15 mg/kg/day (range, 10–20 mg)
# Lfx 100 mg dispersible tablets available for children. Children receiving 6Lfx should be watched for joint abnormalities.
* In children from 0-14 years, 4R should only be used after ruling out active TB in limited geographies/populations for
evidence generation to guide future scale up for country wide implementation.
@ Maximum dose of R would be 600 mg/day.
Note: 6H can be considered as the TPT regimen option for contacts of index patients with RR-TB with FQ and H sensitive,
after ruling out active TB in them.

67. Follow-up monitoring
Individuals on TPT will be monitored by the Doctor for clinical and laboratory
parameters as below:
• Screening with 4S symptoms (cough, fever, night sweats and weight loss)
• Any side effects
• If any of the sign/ symptoms of TB emerge, the person may be referred to the
health facility for further evaluation for active TB/DR-TB disease
• In the above case the person may be subjected to NAAT & LPA for diagnosis of
TB & DR-TB and appropriately managed if found to have developed active
TB/DR-TB disease.
67

68. Follow-up investigations
Urine Pregnancy Test among
women in reproductive age
• As and when clinically
indicated; and
• Discontinue 3HP if
pregnancy is detected and
consider alternative TPT
regimen (e.g. 6H).
Liver function test
• as clinically indicated and
repeated among individuals
who had pre-existing liver
conditions or regular and
harmful alcohol use with
raised enzyme levels at
baseline or previous visit;
and
• Routine LFTs are not
indicated when TPT with 6H
is given in pregnancy unless
there are other risk factors
for liver toxicity.
Monitoring breakdown to
active TB/DR-TB disease
• The monitoring for
breakdown to active TB/DR-
TB disease during TPT or
post-TPT completion for
long-term follow up at 6, 12,
18 & 24 months need to be
done by the doctor/staff of
HF.
68

69. Treatment outcome – treatment completion
69
TB preventive treatment completion
Total
duration
in months
Expected
number
of doses
80% of
recommended
doses (days)
Extended time for
treatment
completion (days)
(treatment
duration +33%
additional time)
6H (daily) 6 180 144 239
3HP (weekly) 3 12 11* 120
6Lfx (daily) 6 180 144 239
4R (daily) 4 120 96 160
* 90% of recommended number of doses
Treatment completion: A person
initiated on TPT who completed at least:
• 80% of recommended dose (144/180)
consumed within 133% of planned TPT
duration (239 days) for 6H or 6Lfx or
• 90% of recommended dose (11/12)
consumed within 133% of planned TPT
duration (120 days) for 3HP or
• 80% of recommended dose (96/120)
consumed within 133% of planned TPT
duration (160 days) for 4R

70. Treatment outcomes- other definitions
• Treatment failed: A person initiated on TPT who developed active TB disease any time while
on TPT course.
• Died: A person initiated on TPT who died for any reason while on TPT course.
• Lost to follow-up: TPT interrupted by person for eight consecutive weeks (2 months) or
more for 6H or 6Lfx, four consecutive weeks (1 month) or more for 3HP or 4R.
• TPT discontinuation due to toxicity: A person whose TPT is permanently discontinued by
the doctor due to adverse events or drug–drug interactions.
• Not evaluated: Such as records lost, transfer to another health facility without record of TPT
completion.
70

71. Innovation by the State and
districts during TPT scale-up
71

72. Local level best practices during TPT scale-up
Key innovations States
Roping in village health committee for TPT 1
Introduction of treatment card, TPT register 4
Advice of TPT to contacts in the prescription of index TB patient from private doctor 2
Decentralized TPT services through health and wellness centre 2
District budget for IGRA lab 1
Introduction of TPT in prison inmates, other risk group and integration during ACF 3
Media and community campaign for awareness generation 1
Training video for counselling by health staff 1
One stop solution – facility based screening 1
72

73. Thank you!!
73

74. Implementation strategy,
recording, reporting and
monitoring of TPT
Dr. Hardik Solanki
WHO National Consultant – TB Prevention
74

75. Key strategies of TPT scale up
75
• Capacity building
• Human resource
• Case finding – active, intensified and passive
• Vulnerability mapping
• Establishment of diagnostic services for ruling out of active TB
• Establishment of TBI testing
• TPT drug and supply chain
• Adherence support
• Robust recording and reporting
• Communication strategies

76. State and district level launch of PMTPT by Chief minister of Madhya Pradesh, Ministers and Administrators of
Assam, Bihar, Chhattisgarh, DNH-DD, Gujarat, Haryana, Himachal Pradesh, Karnataka, Tamil Nādu

77. 28 out of 36 states have constituted State TPT Committee, and 18 states held the meeting till June’22
State TPT Committee meeting in Goa State TPT Committee meeting in Jharkhand
State TPT committee meetings

78. Effort in capacity building
78
• National ToT conducted virtually
through WHO-India’s e-learning
knowledge platform (Swasth e-gurukul)
• ~300 participants (programme managers
and providers) completed national ToT
• For rapid cascade trainings - webinar
based and self learning module was
introduced
• Around 2500 participants enrolled in
training between Aug-Dec’21
• Physical/Hybrid trainings initiated in
2022
• 24,745 private providers sensitized

79. Treatment support
79
Sensitization of
Accredited Social
Health Activity
(ASHA)/
Community
health worker
2.2 lakh
Capacity building
of TB survivors
(TB Champions)
9,444
Sensitization of
PRI members
(local
government body
at village level)
7,654
Treatment support incentives
for TPT completion @Rs. 250
per Rx completion

80. Recording and reporting – Ni-kshay
80
Then (upto 2020)
• Stand alone
contact
tracing
module in Ni-
kshay
• Aggregated
data recorded
Interim (2021)
• Customized
WHO’s
prevent TB
India app
applied for
initial
processes
• Digital record
of individual
on TPT
Now (2022)
• Ni-kshay TPT
module
• Life-cycle approach
– digital record of
all eligible
individual
integrated with
patient workflow
• Adherence, ADR
and drug
dispensation
modules
integrated

81. Nikshay TPT dashboard
• Released in beta version
81

82. Role of medical colleges
• Training / capacity building
• In-house training for faculties
• As a master trainer for training of state/district
staff
• Implementation of TPT services
• Contact tracing
• Rule out of active TB
• Counselling
• TPT and follow up
• ADR management
• Advocacy
• Research
• Supervision and monitoring
• Enumeration of risk group and screening
for TB disease and infection
• ART Centres
• Dialysis unit
• Non-communicable disease Clinics
• Tobacco Cessation Centre
• Deaddiction Centre
• Oncology Clinics
• NRC – Nutritional Rehabilitation Centre
• Performance review during medical college
core committee
82

83. Checklist for supervision of TPT care cascade
Supervisory checklist for TPT case cascade Notes
Advocacy material for TPT ⃝ Available ⃝ Not available
Communication strategy for TPT ⃝ Available ⃝ Not available
TPT implementation as per PIP ⃝ Yes ⃝ No
Status on HR as per work load ⃝ Adequate ⃝ Inadequate
Training status of
• NTEP staff
• Doctors (public & private)
• PPSA staff
• CHOs
• Paramedical staff
• Treatment providers
• TB survivor / champions
⃝ Yes
⃝ Yes
⃝ Yes
⃝ Yes
⃝ Yes
⃝ Yes
⃝ Yes
⃝ No
⃝ No
⃝ No
⃝ No
⃝ No
⃝ No
⃝ No
Supervision would be the responsibility of all cadres of supervisors from states,
district, TB unit, PHC and HWC levels for their respective catchment area for
the entire TPT care cascade and the related programme management system.
83

84. Checklist for supervision of TPT care cascade
Supervisory checklist for TPT case cascade Notes
Contact tracing through line listing ⃝ Done ⃝ Not done
Directory of Treatment supporters ⃝ Available ⃝ Not available
Specimen transport system for sputum and blood in place ⃝ Yes ⃝ No
Status on TBI tests ⃝ Available/ Linkages
established
⃝ Not available/ Linkages not
established
Option of partnership options for diagnostics ⃝ Available ⃝ Not available
Adherence mechanisms ⃝ Treatment supporter
⃝ Tele/video calls
⃝ 99DOTS/MERM
Is the drug stocking and supply chain management adequate ⃝ Yes ⃝ No
84

85. Checklist for supervision of TPT care cascade
Supervisory checklist for TPT case cascade Notes
Number of months of stock available as per consumption and
stocking norm
6H ; 3HP ; 6Lfx ; 4R
Months of stock
Is there a stock-out or low stocks for any TPT regimen courses ⃝ Yes ⃝ No
aDSM system in place ⃝ Yes ⃝ No
Community engagement done ⃝ Yes ⃝ No
Logistics/ trainings for recording & reporting (printing, digital
platform readiness with peripheral devices, internet etc)
⃝ Available ⃝ Not available
Recommended actions:
Name of the facility visited:
Signature of supervisor Designation of supervisor Date of visit
85

86. Monitoring of TPT cascade of care
Steps of care cascade Programmatic benchmarks
1. Total at-risk population Includes all at-risk as per populations identified
2. Total no. screened for active TB disease 100%
3. Total no. tested for TB infection (excluding
those with active TB)
>90% to be tested
4. Total no. eligible for TPT (excluding those
with TBI test negative)
>90%, Includes children > 5yr and adults
5. Total started on TPT >90% among eligible
6. Total completed TPT >90% to complete TPT
7. Total post TPT follow-up for 6m, 12m, 18m
and 24m
>90% of who completed TPT
86

87. TPT coverage
87
* Data annualized for 2022
$ policy of providing TPT to HHC <5years until July 2021; expansion of TPT to all HHC
(irrespective of age) and other risk groups from July 2021
UNHLM – TPT
achievement vs target
(2018-22)
30%
6.86
million
UNHLM
TPT
target
2.07
million
NTEP
Perform
ance
220,092
692,588
56,907
112,323
187,768
437,311 423,706
912,680
-
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
900,000
1,000,000
2017 2018 2019 2020 2021 2022*
No.
of
individual
provided
TPT
PLHIV provided TPT Househol contacts$ provided TPT All individual provided TPT
Household contacts provided TPT $

88. Evaluation of household contacts - National
• Closed the gap in enrolment and line list of contacts - for HHC <5yrs as well as >/=5yrs
88
Care cascade 2021 1-2Q 2022
Contact
tracing
Pulmonary bacteriologically confirmed TB cases (PBCT) 827,566 452,370
PBCT household contact tracing visit 83%
(684,789)
84%
(378,897)
• HHC <5 yrs 156,439 138,008
HHC <5 yrs per PBCT 0.22 0.36
• HHC >/=5 yrs 988,667 1,480,188
HHC >/=5 yrs per PBCT 2.1 3.9

89. 1,466 1,782 6,104 7,294
262,159
294,447 291,729
143,838
36,856
658 255 61
-
50,000
100,000
150,000
200,000
250,000
300,000
350,000
Treated for
TB
Diagnosed
with TB
Evaluated for
TB disease
TB
symptomatics
screened for
TB
HHC <5yrs eligible for
TPT
Put on TPT Completed Failed Stopped TPT
due to ADR
Breakdown to
TB after TPT
completed
89
TPT outcome of individuals put
on 6H in 2021
(N = 78,073 provided TPT)
89
TB and TPT Care Cascade in HHC <5yrs
(Jan-21 to Jun-22)
TB Care Cascade TPT Care Cascade

90. 7,397 9,340 41,174 52,506
2,295,341
2,468,855
1,861,388
397,343
37,873 361 375 71
-
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
Treated for
TB
Diagnosed
with TB
Evaluated for
TB disease
TB
symptomatics
screened for
TB
HHC <5yrs eligible for
TPT
Put on TPT Completed Failed Stopped TPT
due to ADR
Breakdown
to TB after
TPT
completed
TB and TPT Care Cascade in HHC >/=5yrs
(Jul-21 to Jun-22)
90
TPT outcome of individuals put
on 6H in 3-4Q2021
(N = 1,16,814 provided TPT)
TB Care Cascade TPT Care Cascade
HHC >/=5yrs

91. Thank you!!
91