Non-maleficence: do no harm
"Non-maleficence is do no harm. In fact, the new regimen for TB preventive therapy, 3HP, has less hepatotoxicity as it is less toxic to the liver, making it safer and improving adherence if compared to six months of isoniazid preventive therapy - but both are very safe" said Prof Hausler.
Esnath Manhiri from Zimbabwe national network of people living with HIV, agreed: "People living with HIV are at very high risk of getting infected by TB. My message for people living with HIV is that let's go for TB Preventive Therapy (TPT). This new TPT regimen is very short, has less side effects and treatment completion rate is very high. Let us encourage each other to go for TPT so that we can prevent ourselves from getting infected by TB."
Autonomy and justice
"In terms of autonomy, we should be really giving people a choice to access the regimen that they want, so justice comes in - because rifapentine currently is just not affordable at its current price. We need to put pressure on the pharmaceutical companies that produce it to bring down the price so that it becomes affordable and can be implemented more widely in high burden countries like South Africa" said Prof Hausler.
People living with HIV should have access to TB preventive therapy and early antiretroviral treatment. "We really need to get price of rifapentine down so that it can be one of the regimens that is available to people, as well as we have to update guidelines that should include it as an option. We also need to improve treatment literacy for people living with HIV as well as household contacts who are eligible for TB preventive therapy, because then we can increase demand for TPT. We also need a strong monitoring and evaluation framework because if it is not measured and is not considered important then it is not done. Lastly, we do need a very strong multi-sectoral accountability framework so that we can hold all governments, civil society, private sector and all other stakeholders accountable to reach our ambitious TB preventive therapy targets" emphasized Prof Hausler who leads TB HIV Care. TB HIV Care is an organization that works in South Africa to try and prevent TB, screen for TB and increase access to TB and HIV care, in general population and among key populations.
Challenges in roll-out of TB preventive therapy
Esnath Manhiri of Zimbabwe national network of people living with HIV, reflected that "People living with HIV in Zimbabwe are receiving TPT but for now we are getting the old regimen, the six months isoniazid preventive therapy (IPT). Most people are not able to get that because of some side effects associated with it, and we are patiently waiting for the new regimen which has less toxicity and is shorter in terms of course duration. Other challenge we are facing in Zimbabwe is that TPT was decentralized, so in some cases you might see some health facilities are reluctant to give the supply, and some health facilities are running out of supplies of TB preventive therapy. My plea to the governments is to have IPT always available for people living with HIV so that we can prevent TB."
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