By Vivian Mugarisi

The Ministry of Health and Child Care (MoHCC) in collaboration with the World Health Organization (WHO) supported an external review of programmatic management of TB Preventive Therapy (TPT) in Zimbabwe from 5-8 July 2022. This review is an opportunity for the country to have a deeper understanding of lessons learnt so far in implementation of TPT to inform future strategies and further accelerate the rollout. The process is also an opportunity for the country to share best practices with other countries across the globe. The review, being done with funding from UNITAID, brought together TB experts, from key partners and researchers who include Aurum Institute, Clinton Health Access Initiative (CHAI), Elizabeth Glaser Paediatric Foundation (EGPAF), Jointed Hands, Rehabilitation and Prevention of Tuberculosis (RAPT), Stop TB Partnership Zimbabwe, The Union Zimbabwe Trust.

The Government of Zimbabwe through MoHCC, introduced shorter regimens for TPT in 2020. This was done to ensure that high risk people who include people living with HIV (PLWHIV), children below the age of 15 years and all contacts of confirmed TB patients have access to shorter and safer TB preventive therapy to prevent them from developing TB disease. Zimbabwe is also one of the countries that adopted and adapted the new WHO consolidated guidelines on tuberculosis: Module 1: Prevention: tuberculosis preventive treatment. Furthermore, the country has been identified as one of the countries in the world that has shown impressive progress in the rollout of shorter TPT. W Funding support for the implementation of TPT in Zimbabwe is also coming the Global Fund, PEPFAR, USCDC, UNITAID and USAID among other partners

Zimbabwe is one of the countries heavily burdened by TB, TB/HIV and Multi-Drug Resistant TB (MDR-TB). Just over a tenth (11.58%) of the country’s adults are living with HIV and the TB estimated incidence was 193/100,000 people in 2020. TB is also primarily an HIV-driven epidemic with TB/HIV co- infection rate in Zimbabwe estimated to be 54% in 2020.

“We are grateful to the support provided by donor organizations and technical partners. The review is an opportunity for the country to take stock of this important intervention to re-strategize and to further accelerate the roll out plan for TB Preventive Therapy,” said Dr Charles Sandy, MoHCC Deputy Director AIDS and TB Programmes.

Following the review, a report will be produced that will help Zimbabwe develop an action plan to further strengthen the roll out of TB preventive therapy.

Clinton Health Access Initiative (CHAI) Zimbabwe representative, Nicole Kawaza, highlighted the importance of increasing investments across the TB continuum of care for household contacts of TB patients through strengthening contact investigation efforts as an entry point to TB treatment and TB Preventative Therapy.

“Platforms such as the PMTPT review reaffirm the importance of TPT as prevention of TB disease is often easier, faster and less expensive that the remedial action of TB treatment,” she said.

At the first-ever  UN High Level Meeting on Tuberculosis  (UNHLM on TB), on held 26 September 2018, one of the major commitments was to rapidly scale up access to testing and treatment of TB infection  and  provide 30 million  individuals with TB preventive treatment (TPT). WHO has since then consolidated its guidelines for programmatic management of TPT and recommended the use of shorter TPT regimens that facilitate uptake, particularly the 3 month weekly regimen of isoniazid and rifapentine (3HP) and 3 month daily regimen of isoniazid and rifampicin (3RH). Before the shorter treatment options, the standard regimen required a minimum of 6 months of INH, but its effectiveness has been limited by poor completion rates caused by long treatment duration and side effects.

“The review will assist the country to enlist key bottlenecks in expansion and national scale up of TPT services such as funding, human resources, health worker capacity, procurement and supply chain management and identify areas for strengthening of programmatic management of TPT at different levels in Zimbabwe,” said Dr Avinash Kanchar, Medical Officer in TB Prevention, Treatment, Care & Innovation unit of the WHO Global TB Programme in Geneva.