Oh Kyung Hyun, Teo Alvin Kuo Jing, Yanagawa Manami, Kanchar Avinash, Falzon Dennis, Miller Cecily, Choi Youngeun, Lee Gyeong In, Morishita Fukushi, Rahevar Kalpeshsinh, Tran Huong Thi Giang, Yadav Rajendra Prasad Hubraj
World Health Organization Regional Office for the Western Pacific, Manila, Philippines.
Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
Trop Med Health. 2025 Sep 2;53(1):122. doi: 10.1186/s41182-025-00805-6.
Tuberculosis preventive treatment (TPT) can avert progression from infection to disease, yet scale-up across the World Health Organization Western Pacific Region is patchy. To guide acceleration, we assessed progress, challenges and responses in seven high-burden countries-Cambodia, China, Lao People's Democratic Republic (PDR), Mongolia, Papua New Guinea, the Philippines and Viet Nam-drawing on 2015-2023 programme data, structured questionnaires, follow-up interviews and a regional validation workshop.
Six of the seven countries have issued national TPT guidelines and five now offer shorter rifapentine- or rifampicin-based regimens. The number of people started on TPT rose sharply in most settings, driven by household contacts aged ≥ 5 years in Cambodia, Mongolia and the Philippines and by people living with HIV in Lao PDR and Papua New Guinea. However, coverage of children under five and other high-risk groups remains low. Cascade analysis revealed major attrition between screening and TPT initiation. Key obstacles, viewed through a socio-ecological lens, include: individual complacency, fear of adverse events and limited provider confidence; stigma and consent barriers in migrant households; intermittent staff training, medicine stock-outs and weak digital tools; long journeys to health facilities; and policy-practice gaps such as the absence of child-friendly formulations and non-notification of tuberculosis infection. Countries and partners endorsed a tiered package combining patient-centred counselling, mobile reminders, shorter paediatric regimens, stigma-reduction campaigns and remote e-consent. Health systems will reinforce staff training, digital supply-chain and adherence tools, while decentralised one-stop outreach and community health-workers extend coverage. A multisector task force will fast-track paediatric fixed-dose registration, make infection notifiable and absorb preventive treatment costs into national budgets and insurance schemes.
The introduction of shorter regimens and rising enrolment confirm that rapid gains are achievable, yet wide disparities persist across age groups, risk categories and care-cascade stages. Implementing the agreed client, community, institutional and policy interventions-backed by integrated governance and sustainable domestic funding-can convert TPT from a promising guideline into a routine, life-saving component of primary health care throughout the Western Pacific Region.
结核病预防性治疗（TPT）可避免感染发展为疾病，但世界卫生组织西太平洋区域的推广情况参差不齐。为指导加速推广，我们利用2015 - 2023年项目数据、结构化问卷、随访访谈以及区域验证研讨会，评估了柬埔寨、中国、老挝人民民主共和国、蒙古、巴布亚新几内亚、菲律宾和越南这七个高负担国家的进展、挑战及应对措施。
七个国家中有六个已发布国家结核病预防性治疗指南，五个国家现在提供基于利福喷汀或利福平的更短疗程方案。在大多数地区，开始接受结核病预防性治疗的人数急剧上升，这在柬埔寨、蒙古和菲律宾是由5岁及以上的家庭接触者推动的，在老挝人民民主共和国和巴布亚新几内亚是由艾滋病毒感染者推动的。然而，五岁以下儿童和其他高危群体的覆盖率仍然很低。级联分析显示，筛查和开始结核病预防性治疗之间存在重大流失。从社会生态角度来看，主要障碍包括：个人自满、对不良事件的恐惧以及提供者信心有限；移民家庭中的耻辱感和同意障碍；间歇性的工作人员培训、药品短缺以及薄弱的数字工具；前往医疗机构的路途遥远；以及政策与实践之间的差距，例如缺乏适合儿童的制剂以及未通报结核病感染情况。各国及合作伙伴认可了一套分层方案，该方案结合了以患者为中心的咨询、移动提醒、更短的儿科疗程、减少耻辱感运动以及远程电子同意。卫生系统将加强工作人员培训、数字供应链和依从性工具，而分散的一站式外展服务和社区卫生工作者将扩大覆盖范围。一个多部门特别工作组将加快儿科固定剂量制剂的注册，使感染情况可通报，并将预防性治疗费用纳入国家预算和保险计划。
引入更短疗程以及登记人数的增加证实，快速取得进展是可以实现的，但不同年龄组、风险类别和治疗级联阶段之间仍存在巨大差距。实施商定的针对患者、社区、机构和政策的干预措施，并辅以综合治理和可持续的国内资金支持，可以将结核病预防性治疗从一项有前景的指南转变为整个西太平洋区域初级卫生保健的常规、挽救生命的组成部分。
