References in the content below refer to the PBMEF Guide.
Definitions
Number of eligible individuals who were started on tuberculosis (TB) preventive treatment (TPT) according to national TB prevention treatment protocols during the reporting period. This includes: (1) household contacts (adults and children under 5) of people with bacteriologically confirmed pulmonary new and relapse TB cases notified, and (2) people living with HIV (PLHIV) enrolled in HIV care.
Individuals who are eligible for TPT are those who are ruled out for TB disease and meet other criteria as specified in the national TB prevention treatment guidelines or protocols.
According to World Health Organization (WHO) TPT guidelines:
A household contact is a person who shared the same enclosed living space as the index case for one or more nights or for frequent or extended daytime periods during the three months before the start of current treatment.
An index case (index patient) of TB is the initially identified person of any age with new or recurrent (bacteriologically confirmed pulmonary) TB in a specific household or other comparable setting in which others may have been exposed.
An index case is the person on which a contact investigation is centered but is not necessarily the source case.
Numerator
Denominator
Ref # |
PT-1
|
Tier Level |
Core Indicator
|
Category |
Prevent
|
Type |
Core Outcome
|
Unit of Measure |
Number of eligible individuals
|
Data Type |
Integer
|
Disaggregations |
Contacts under 5 years of age
Contacts over 5 years of age
PLHIV
|
Reporting Level |
National
|
Reporting Frequency |
Annually
|
National TB program (NTP) official records report on this indicator. Some NTPs may include TPT initiation on the quarterly report on TB case registration or quarterly report on TB treatment outcomes, but this may vary country to country. In other settings, this data is available at the individual (casebased) levels through the NTP or HIV/AIDS program for PLHIV.
This standard WHO indicator has a new formula as of 2020. Before 2020, it can be calculated using the WHO database variable: newinc_con_prevtx plus hiv_ipt_reg_all. Starting in 2020, the formula is newinc_con_prevtx + (the first non-empty variable in the following order: hiv_ipt_reg_all, hiv_ipt, hiv_all_tpt, hiv_elig_all_tpt, hiv_new_tpt, hiv_elig_new_tpt). One should use caution when comparing before and after 2020.
Prevention of new infections of mycobacterium TB and their progression to TB disease is critical to reduce the burden of ill health and death caused by TB, and to achieve the End TB Strategy targets set for 2030 and 2035. This indicator, when measured over time, provides information on the trajectory of TPT scale-up and helps assess progress towards United Nations High Level Meeting (UNHLM) targets.
Globally in 2019, 33% of children under 5 years household contacts of bacteriologically confirmed TB, and 50% of PLHIV were initiated on TPT. While PLHIV are on track to reach the UNHLM target of 6 million on TPT, the number of children under 5 years and adult household contacts placed on TPT are falling short of the numbers required to meet the targets (4 million and 20 million, respectively).
TPT coverage data will help program managers monitor TB prevention efforts targeted towards protecting people who are exposed to TB infection and are at risk of becoming sick. Understanding TPT coverage will also reduce the risk of transmission in the community and, thereby, reduce incidence of TB disease in the country. TPT coverage levels will also indicate the success of a country’s implementation of the TPT strategy and robustness of programmatic management of TPT.
A trend analysis of this indicator can track progress over time as TPT interventions scale up. A cascade of care can also highlight the gaps between contact investigations, finding individuals who are eligible for TPT14 and finding those who are initiated on TPT. TPT coverage can further be broken down to understand what proportion of cases initiated on TPT is made up of PLHIV, contacts under 5 years of age, and contacts over 5 years of age for reporting against UNHLM targets. See Appendix 2 for a more detailed TPT pathway and cascade of care.