TB Preventive Therapy

When a person with active TB who is not on TB treatment coughs, sneezes or breathes, the TB bacteria is spread in the air. The bacteria can stay in the air for a few hours, depending on the ventilation in the room. An uninfected person can inhale the TB bacteria and get infected with TB. This person may not present with TB symptoms (coughing, fever, night sweats, unexplained weight loss), as the bacteria can exist in a ‘sleeping mode’ in the body. This is called latent TB. A person with latent TB cannot infect others, however, latent TB can progress to active TB in about one in ten people.

The World Health Organization (WHO) recommends that the close contacts of a person who has been diagnosed with TB disease and people living with HIV should be screened for TB disease with a rapid molecular sputum test (Nucleic Acid Amplification Test – NAAT) that detects the genetic material of the TB bacterium. If active TB disease has been ruled out the person should be offered TB Preventive Therapy to prevent them from getting sick with TB disease.

What TPT is available?

There are various TB Preventive Therapy options, depending on various factors, which could include taking treatment for anything between one to twelve months, as one of the following options:

6H, 9H & 12H: isoniazid taken daily for six, nine, 12 months. This was previously called IPT (Isoniazid Preventive Therapy)
3HP: isoniazid and rifapentine taken once a week for three months = a total of 12 doses. The use of 3HP has not yet been studied in children and is not yet recommended.
1 HP: isoniazid and rifapentine taken once a day for one month
3 HR: isoniazid and rifampicin taken once a day for three months
4R: four months of daily rifampicin.

TB Preventive Therapy is a key component of TB prevention in TB-affected communities.

Aims

The overall goal of this project is to improve access to TPT those at-risk in South Africa.

We believe that TB Preventive Therapy should be a key component of TB prevention in TB affected communities.

For more information on latent TB infection, please consult the WHO Latent TB Infection: Updated and consolidated guidelines for programmatic management.

Another useful link: An activist’s guide to Rifapentine for the treatment of TB infection.

Project Achievements

1. Advocacy/ policy and decision maker engagement

TB Proof has been a leading advocate for the implementation of updated TB policies under South Africa’s National Strategic Plan (NSP) for HIV, AIDS, STIs, and TB (2023–2028). In collaboration with civil society partners, TB Proof developed advocacy letters in 2023 and 2024 sent to the Minister of Health to address gaps in TB prevention.

At the provincial level, TB Proof collaborated with the Western Cape Department of Health to drive actionable steps for scaling up TPT implementation. In 2023, an advocacy letter (access here) was submitted to the Premier, outlining key recommendations such as training health workers on new TB policies, launching community awareness campaigns, and integrating TPT data into the provincial TB dashboard.

At the district level, TB Proof’s engagement with the Khayelitsha Eastern Substructure (KESS) has been instrumental in building momentum for TPT uptake. A TB Imbizo co-hosted with the Western Cape Department of Health and Civil Society Organisations in 2024 brought together over 130 stakeholders, including healthcare workers, TB survivors, and community leaders, to strategise on local implementation of TPT policies. The Imbizo led to a commitment to monthly TB meetings in Khayelitsha.

2. Demand creation and community engagement

TB Proof launched impactful initiatives to engage communities and increase demand for TB prevention services.

Community engagement activities included:

Co-developing Information, Education, and Communication (IEC) materials with the Western Cape Department of Health in three languages to raise awareness of TPT (access here).
Producing short films to highlight the importance of testing and accessing TPT for TB contacts
Developing 30-second television ads on TPT featuring TB survivors.
Multiple in person health exhibitions, school events, and community gatherings.

Through these combined efforts, TB Proof has effectively connected high-level policy advocacy with grassroots demand creation, ensuring TB prevention and care is accessible and prioritised across communities.

Our advocacy projects

CHW TB Champions

A community health worker (CHW) is a representative of a specific community. They have earned the communities’ trust to enter their homes and assist them to improve their health status.

TB Stigma Project

Stigma is a term describing the feeling of being ashamed, or experiencing societal disapproval in the way that other people treat you.

All oral drug-resistant TB Treatment

For many years patients were given a difficult choice: die because of drug resistant TB or become deaf as a results of the treatment.

TB IPC Training

Healthcare workers (HCWs) are three times more likely to be infected by TB than the general public and six times more likely to be hospitalized with drug-resistant TB.