OpiniãoThe recommendations and the text of the WHO consolidated guidelines on tuberculosis. Module 1: Prevention – tuberculosis preventive treatment, second edition are the result of collaboration among professionals in various specialties with extensive expertise and experience in public health policy, tuberculosis (TB) programme management and the clinical care of TB patients. The recommendations in these guidelines were developed by successive guideline development groups (GDGs) convened by WHO, the latest of which met in December 2023. WHO gratefully acknowledges the contributions of all experts involved in preparation of these guidelines.¹
The production and writing of these guidelines were coordinated by Avinash Kanchar, Dennis Falzon, Saskia den Boon and Matteo Zignol under the overall direction of Tereza Kasaeva, Director of the WHO Global Tuberculosis Programme.
Guideline Development Group
The GDG was composed of Mênonli Adjobimey (National TB Programme, Benin), Rolando Cedillos (University of El Salvador and Hospital Nacional Rosales, El Salvador), Ana Ciobanu (formerly National TB Programme, Republic of Moldova), Alexander Kay (Baylor College of Medicine, Eswatini), Naira Khachatryan (National TB Programme, Armenia), Amir Khan (Professional Association for Social Development, Pakistan), Blessina Kumar (Global Coalition of TB Advocates, India), Natalia Litvinenko (National Institute of TB and Lung Diseases, Ukraine), Nasehi Mahshid (TB Programme Manager, Tehran, Islamic Republic of Iran), Charisse Malbacias (Department of Health, Philippines), Alberto Matteelli (University of Brescia, Italy), Norbert Ndjeka (National Department of Health, South Africa), Senia Rosales Klintz (European Centre for Disease Prevention and Control, Sweden), Nicole Salazar Austin (Johns Hopkins Center for Clinical Global Health Education, United States of America [USA]), Susan Swindells (University of Nebraska, USA), Stavia Turyahabwe (Ministry of Health, Uganda) and Paran Winarni (Global Tuberculosis Community Advisory Board, Indonesia). The Chair of the GDG was Norbert Ndjeka, and the GRADE methodologist was Lawrence Mbuagbaw (McMaster University, Canada).
External reviewers
The External Review Group (ERG) was composed of Helen Ayles (London School of Hygiene and Tropical Medicine, United Kingdom of Great Britain and Northern Ireland [United Kingdom]), Anurag Bhargava Yenepoya Medical College Hospital, India), Gavin Churchyard (The Aurum Institute, South Africa), Raquel Duarte (European Respiratory Society and University of Porto, Portugal), Amita Gupta (Johns Hopkins University, USA), Anthony D Harries (International Union Against Tuberculosis and Lung Disease, France), Nino Lomtadze (National TB Programme, Georgia), Ruslan Malyuta (UNICEF), Giovanni B. Migliori (Maugeri Research Centre, Italy), Lindiwe Mvusi (National Department of Health, South Africa), Anastasia Samoilova (National TB Programme, Russian Federation), Alena Skrahina (Republican TB Centre, Belarus), Carrie Tudor (Johns Hopkins University School of Nursing, USA) and Valentina Vilc (National TB Programme, Republic of Moldova).
Evidence reviewers
Harsimren Sidhu, Stephanie Law and Richard Menzies (McGill University, Canada) undertook the systematic evidence review, the country survey on feasibility and the qualitative study of contacts, and provided summaries of the research for the GRADE evidence-to-decision table on use of levofloxacin in contacts exposed to multidrug-resistant TB (PICO 10; see annexes 3-5). The following presented the findings of studies relevant to the PICO question to the GDG: Gregory Fox (University of Sydney and Woolcock Institute of Medical Research, Australia), Anneke Hesseling and Thomas Wilkinson (Stellenbosch University, South Africa), Trinh Duong (University College London, United Kingdom), Leonardo Martinez (Boston University, USA) and James Seddon (Imperial College London, United Kingdom).
WHO Guideline Steering Group
The Guideline Steering Group was composed of Annabel Baddeley, Annemieke Brands, Saskia den Boon, Dennis Falzon, Nazir Ismail, Avinash Kanchar, Cecily Miller, Fuad Mirzayev, Sabine Verkuijl, and Matteo Zignol (WHO Global Tuberculosis Programme); Françoise Renaud, Marco Antonio De Avila Vitoria and Elena Vovc (Global HIV, Hepatitis and STIs programmes); Andreas Reis (Office of the Chief Scientist); Lorenzo Moja (Division of Access to Medicines and Health Products); Jean-Louis Abena (WHO Regional Office for Africa); Pedro Avedillo (WHO Regional Office for the Americas); Vineet Bhatia (WHO Regional Office for South-East Asia); Askar Yedilbayev (WHO Regional Office for Europe); Martin van den Boom (WHO Regional Office for the Eastern Mediterranean); and Kyung Hyun Oh (WHO Regional Office for the Western Pacific).
Others
The following participated as observers at the GDG meeting: Sevim Ahmedov (US Agency for International Development (USAID), USA); Andrew Burke, Frances Garden, Tasnim Hasan, Thomas Lung and Thu Anh Nguyen (University of Sydney, Australia); Sapna Bamrah Morris and Anand Date (US Centers for Disease Control and Prevention, USA); Siobhan Carroll (McGill University, Canada); Jacob Creswell (Stop TB Partnership, Switzerland); Celeste Gracia Edwards (The Global Fund, Switzerland); Agnes Gebhard (KNCV Tuberculosis Foundation, Kingdom of the Netherlands); Diana Gibb, Yohhei Hamada and Molebogeng (Lele) Rangaka (University College London, United Kingdom); Kobto Koura (International Union Against Tuberculosis and Lung Disease, France); Simon H. Schaaf (Stellenbosch University, South Africa); Cherise Scott (UNITAID, Switzerland); and Giorgia Sulis (University of Ottawa, Canada).
WHO acknowledges the contribution of the Guideline Review Committee in reviewing and approving the guidelines before their publication.
Funding
Production of the WHO consolidated guidelines on tuberculosis. Module 1: Prevention – tuberculosis preventive treatment, second edition was funded by grants to WHO from USAID, the US Centers for Disease Control and Prevention and Unitaid.
Recommendations for tuberculosis preventive treatment, 2020 update
Guideline Development Group
The GDG of the 2020 update of the WHO consolidated guidelines on tuberculosis: tuberculosis preventive treatment was composed of Mohammed Al Lawati (consultant physician, Oman); Helen Ayles (Infectious Diseases and International Health, London School of Hygiene and Tropical Medicine, Zambia); Rolando Cedillos (Service of Infectious Diseases and Integrated Programme for STI/HIV/AIDS, El Salvador); Padmapriyadarsini Chandrasekaran (National Institute for Research in Tuberculosis, India); Diana Gibb (Medical Research Council, United Kingdom); Yohhei Hamada (Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Japan); Anthony D. Harries (International Union Against Tuberculosis and Lung Disease, France; and London School of Hygiene and Tropical Medicine, London, Uniyed Kingdom); Alexander Kay (Baylor College of Medicine, Global TB Program, Eswatini); Nasehi Mahshid (Department of TB and Leprosy Control, Centre for Control of Communicable Diseases, Ministry of Health and Medical Education, Islamic Republic of Iran); Alberto Matteelli (University of Brescia, WHO Collaborative Centre for TB/HIV and TB Elimination, Italy); Lindiwe Mvusi (National Department of Health, South Africa); Kuldeep Singh Sachdeva (National Tuberculosis Elimination Programme, India); Nandi Siegfried (Medical Research Council / University of Cape Town, South Africa); Ezio Távora dos Santos Filho (WHO Civil Society Task Force member, Brazil); Marieke van der Werf (European Centre for Disease Prevention and Control, Sweden); Wim Vandevelde (Global TB Community Advisory Board, South Africa); and Irina Vasilyeva (Ministry of Health, Russian Federation). The co-chairs of the GDG were Lindiwe Mvusi and Nandi Siegfried. Dr Siegfried was also the GRADE methodologist
External reviewers
The External Review Group (ERG) was composed of Connie Erkens (KNCV TB Foundation, Kingdom of the Netherlands); Steve Graham (Center for International Child Health University of Melbourne, Australia); Giovanni B. Migliori (Maugeri Research Centre, Italy); Rohit Sarin (National Institute of TB and Respiratory Diseases, India); James Seddon (Imperial College London, United Kingdom); Alena Skrahina (Republican Scientific and Practical Centre for Pulmonology and TB, Belarus); and Carrie Tudor (International Council of Nurses, South Africa). Edits to the draft guidelines were also provided by people who responded to the call for public review on 1 July 2019.
Evidence reviewers
The following people contributed to the reviews and summarization of evidence for the guidelines:
Mayara Bastos, Jonathon Campbell and Richard Menzies (McGill University, Canada) provided the first draft of estimates and footnotes for the GRADE summary of evidence table from the trials of 4 months of daily rifampicin (PICO 6).
Richard Chaisson and Ritesh Ramchandani (Johns Hopkins University, USA) and Susan Swindells (University of Nebraska Medical Center, USA) provided the first draft of estimates and footnotes for the GRADE summary of evidence table from the BRIEF-TB/A5279 trial of 1 month of daily rifapentine and isoniazid (PICO 7).
Yohhei Hamada (Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Japan) researched and wrote the report on the systematic review and meta-analysis of the safety of isoniazid preventive treatment in pregnancy (PICO 9), with support from Carmen Figueroa (WHO Global Tuberculosis Programme) and Mario Sánchez (WHO Management of Non-communicable Diseases, Disability, Violence & Injury Prevention). Lynne M. Mofenson (Consultant, WHO HIV Department) contributed a qualitative review of the safety of isoniazid in pregnancy. Amita Gupta and Nicole Salazar-Austin (Johns Hopkins University, USA) provided unpublished information from their studies to complete the evidence review.
WHO Guideline Steering Group
The WHO Guideline Steering Group was composed of Annabel Baddeley, Annemieke Brands, Dennis Falzon, Carmen Figueroa, Medea Gegia, Christopher Gilpin, Philippe Glaziou, Avinash Kanchar and Matteo Zignol (WHO Global Tuberculosis Programme); Françoise Renaud and Satvinder Singh (WHO Department of HIV/AIDS); Andreas Reis (Department of Information, Evidence and Research); and Lorenzo Moja (Department of Essential Medicines and Health Products). Wilson Were (WHO Department of Maternal, Newborn, Child and Adolescent Health) also reviewed the guidelines.
Others
The following people participated as observers at the GDG meetings: Sevim Ahmedov (US Agency for International Development (USAID), USA); Draurio Barreira Cravo Neto (Unitaid, Switzerland); Anand Date (Centers for Disease Control and Prevention, USA); Lucia Gonzalez Fernandez (International AIDS Society, Switzerland); Harry Hausler (TBHIV Care, South Africa); Cecily Miller (University of California San Francisco, USA); Surbhi Modi (Centers for Disease Control and Prevention, USA); Suvanand Sahu (Stop TB Partnership, Switzerland); Anna Scardigli (Global Fund to Fight AIDS, TB and Malaria, Switzerland).
WHO acknowledges the contributions of the Guideline Review Committee and its WHO secretariat in reviewing and approving the guidelines before their publication.
Funding
The 2020 update of the WHO consolidated guidelines on tuberculosis: tuberculosis preventive treatment was funded by grants provided to WHO by the US Agency for International Development (USAID) and the Russian Federation.
¹ More information on the areas of expertise, gender and geographical distribution, declarations of interests and the management of potential conflict of members of the 2023 GDG and the External Review Group are summarized in Annex 2.