February 7, 2025
WHO operational handbook 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 second edition of the WHO operational handbook on tuberculosis: tuberculosis preventive treatment is the companion, implementation guide to the second edition of the WHO guidelines on TPT released in 2024. The first editions of these guidelines and handbook were published in 2020. 

Overview

The handbook provides practical advice on how to implement the WHO recommendations on TPT at the scale needed to achieve national and global impact. Its chapters cover critical steps in the programmatic management of TPT following the cascade of preventive care: identifying individuals at highest risk, testing for infection, screening and ruling out TB disease, choosing the preventive treatment option that is best suited to an individual, managing adverse events, supporting medication adherence and monitoring programmatic performance. The dosage schedules for TPT regimens have been completely redone since the first edition of the handbook and best practices from country and partner interventions have been included. Ethical considerations in the programmatic management of TPT continue to be emphasized. The annexes include useful resources such as the investment case for screening and preventive treatment, sample text for advocacy messaging, monitoring tools, and considerations for coordination and budgeting for national strategic planning and resource mobilization. Although its focus is on high TB and HIV burden settings, the advice in the handbook is also relevant for other contexts. This book is intended to guide policy-makers within ministries of health and other institutions, and stakeholders involved in health care, including HIV and TB programme managers at national, subnational and district levels; health workers and staff of development and technical agencies, nongovernmental organizations as well as civil society and community-based organizations supporting TPT services. 

 

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