WHO consolidated guidelines on tuberculosis Module 1: prevention

Overview

Background

About one fourth of the world’s population is estimated to have been infected with the tuberculosis (TB) bacilli, and about 5–10% of those infected develop TB disease in their lifetime. The risk for TB disease after infection depends on several factors, the most important being the person’s immunological status. TB preventive treatment (TPT) given to people at highest risk of progressing from TB infection to disease remains a critical element to achieve the global targets of the End TB Strategy, as reiterated by the second UN High Level Meeting on TB in 2023. Delivering TPT effectively and safely necessitates a programmatic approach to implement a comprehensive package of interventions along a cascade of care: identifying individuals at highest risk, screening for TB and ruling out TB disease, testing for TB infection, and choosing the preventive treatment option that is best suited to an individual, managing adverse events, supporting medication adherence and monitoring programmatic performance.

The 2024 recommendations for the programmatic management of TPT are released as part of Module 1 of the WHO consolidated TB guidelines series. The guidelines are complemented by an operational handbook, that provides practical advice on how to implement the recommendations at the scale needed to achieve national and global impact. The guidelines and the handbook are the second edition of the documents and update the edition that was first published in 2020.

Overview

The 21 recommendations contained in the second edition of the guidelines cover critical steps in programmatic management of TPT. The main changes from the first edition of the guidelines include a new, strong recommendation on TPT for contacts of multidrug- or rifampicin-resistant TB (MDR/RR-TB); the integration of recommendations from the 2021 WHO TB screening guidelines and the 2022 WHO guidelines on testing of TB infection; withdrawal of two older recommendations that presented issues to implementation; revisions to the wording of recommendations to align with current terminology; and updates to the research gaps and references.

The operational limitations that need to be overcome by countries to achieve global targets are highlighted and discussed in greater detail in the accompanying operational handbook that is being released concurrently. The guidelines and handbook are to be used primarily in national TB and HIV programmes, or their equivalents in ministries of health, and for other policy-makers working on TB, HIV and infectious diseases in public and private sectors and in the community.