CAPE TOWN, 16 February 2021—Advocates and affected communities working towards the global scale-up of short-course TB preventive therapy (TPT) hail the recent announcement of the launch of decently priced, patient-friendly fixed-dose combinations (FDC) of 3HP in five high burden HIV and TB countries. This news, made possible by the Unitaid-funded IMPAACT4TB project, comes at an opportune time as communities grapple with the devastation wrought by the COVID-19 pandemic, which has stressed struggling healthcare systems and set back efforts to expand access to TB prevention services. “In most of our countries, preventing TB remains a worthwhile public health investment,” noted Jerry Amoah-Larbi from the Ghana National TB Voice Network. “These FDC 3HP treatments are a game-changer for communities affected by HIV and TB, who face the double-stigma from public misperceptions that all coughs are caused by COVID-19. Not every cough is COVID-19! Preventing TB is an urgent priority for our communities.”
TPT has been available in most middle-to-low-income countries for decades. Yet often the six, nine, 12, or 36-month treatment journey on isoniazid preventive therapy (IPT)—a daily regimen of the drug isoniazid—remains tedious, lonely, and difficult for people to complete in full. Chimwemwe, a Malawian woman who has been living with HIV since 2015 and started taking IPT in 2017, faced a lot of adherence challenges taking IPT. Side effects include periodic skin rash, severe headaches, and sometimes extreme lethargy, which hindered her ability to complete her work. For most people living with HIV, the pill burden of taking antiretrovirals (ARVs) together with TPT continues to be a barrier, resulting in most people stopping their IPT.
At just 12 doses taken over 12 weeks, the 3HP regimen is shorter than IPT, and the new FDC tablets will make it even easier for people to complete. The tablets combine isoniazid with a second drug, rifapentine. A complete patient-course of 3HP using the Macleods FDC is priced at $15 for 138 countries under a Unitaid-negotiated agreement valid through 2021. The Global Fund Expert Review Panel has approved the Macleod’s FDC product, meaning countries can use donor resources from the Global Fund and U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) to purchase it.
“People-centered responses need to go hand in hand with patient-friendly treatments. One can never exist without the other,” said Patricia Osero, Director of DACASA, Kenya. “There is now need for speed, as community education and mobilisation must translate into treatment access. Our programmes must initiate 3HP regimens with no further delays.”
The launch of this new 3HP formulation represents years of impatient advocacy by communities affected by TB and HIV. “Advocates built demand for 3HP in communities, conducted treatment literacy workshops to share information on the regimen, cleared potential patent barriers to generic entry, pushed governments to update TB prevention guidelines, and called on donors to commit to scaling-up short-course TPT regimens to meet the global goal of treating 30 million people with preventive therapy by 2022,” said Lynette Mabote, advocacy advisor with Treatment Action Group.
As HIV and TB communities continue to build a growing global movement for TPT access, Dr. Joaquim Manhique, the Director of civil society organization Kenguelekeze in Mozambique, calls on governments to prioritise TPT, particularly the 3HP regimen, within their TB and HIV catch-up plans as an emergency response to COVID-19. He joins his fellow comrades from Africa, Asia, and Latin America in calling for more generic manufacturers to enter the market, and for all suppliers to do the right thing and make the prices of these commodities affordable.
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