تعليقThe WHO consolidated guidelines on tuberculosis: tuberculosis preventive treatment include recommendations for the four milestones in the cascade of preventive care, namely identification of risk groups, TB screening and ruling out TB, testing for TBI, and choice and administration of the TPT regimen. The second edition of the TPT guidelines will have the same scope.
Since the previous update of the guidelines, in 2020, several developments have affected TPT policy. They include revision of WHO guidance on screening for TB disease and new modalities for testing for TBI (13,14). In addition, two landmark trials of use of TPT for contacts of people with MDR-TB have been completed (15,16). In the light of these new developments and continued demand from Member States for guidance on how best to protect people at risk of TB, the 2020 TPT guidelines were updated to ensure that the recommendations continue to be based on the latest available evidence.
The current update considered a review of evidence on one question, worded in PICO format²:
- Does TPT with levofloxacin improve outcomes in contacts exposed to MDR- or RR-TB as compared with other regimens or no treatment?
The methods used by the expert groups and evidence retrieval are further described in annexes 2–5. In making decisions on the wording and strength of the recommendation, the GDG considered the evidence not only for the effectiveness and safety of an intervention but also other dimensions important to both the people at risk and the programme, namely values, preferences, resource requirements, cost, impact on health equity, acceptability and feasibility, as is seen in the GRADE evidence-to-decision tables (Annex 4). A summary of unpublished data also used in formulating the new recommendation is provided in Annex 5 (17,18).
Other changes made to the guidelines are summarized in Box 1. The recommendations in the second edition are compared with those in the 2020 guidelines in Annex 1.
2 Population, Intervention, Comparator and Outcome. See annexes 2 and 3 for a complete listing of PICOs and evidence summaries from guidelines since 2018.