Maharashtra Starts 1HP To Prevent TB In People Living With HIV

In a groundbreaking move to enhance Tuberculosis Preventive Treatment (TPT) for individuals living with HIV (PLHIV), the Maharashtra government has introduced a new drug regimen known as 1HP. This initiative significantly shortens the duration of medication from six months to just 28 days, a change that officials believe will improve treatment adherence and outcomes for this vulnerable population.

Understanding Tuberculosis and Its Risks for PLHIV

Tuberculosis (TB) is a serious infectious disease primarily caused by the bacterium Mycobacterium tuberculosis. While it predominantly affects the lungs, it can also impact other vital organs such as the spine, brain, and kidneys. Individuals with weakened immune systems—like those living with HIV, diabetics, and the malnourished—are at an elevated risk of contracting TB. Notably, TB remains the leading cause of death among PLHIV, underscoring the urgent need for effective preventive measures.

Historically, since 2016, TPT for PLHIV involved a regimen of Isoniazid, requiring 180 doses over six months. This lengthy treatment duration often posed challenges in patient adherence, particularly in areas with high rates of both HIV and TB. However, the introduction of the 1HP regimen represents a significant shift in strategy, aiming to provide more efficient and effective treatment.

The 1HP Regimen: A New Hope

Starting last month, Maharashtra has adopted the 1HP regimen under the National Tuberculosis Elimination Programme (NTEP). This new protocol entails administering a combination of Rifapentine and Isoniazid in just 28 doses, significantly reducing the burden on patients compared to the previous 180 doses. According to Dr Aniruddha Kadu, a consultant for the World Health Organization (WHO) in Maharashtra, this change is expected to enhance adherence among PLHIV who are at risk of TB.

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Dr Kadu emphasized the importance of screening for TB among PLHIV visiting Anti-Retroviral Therapy (ART) centres and Integrated Counselling and Testing Centres (ICTCs). All patients presenting with symptoms such as cough, fever, night sweats, or weight loss undergo TB testing. Those who test positive are promptly treated for TB, while those who test negative are placed on the new TPT regimen. This proactive approach is designed to catch TB infections early, improving health outcomes for PLHIV.

Integrated Treatment Approach

The Maharashtra government has established a streamlined process for treating PLHIV, combining HIV and TB treatment into a single-window facility. This integration means that patients can receive both TPT and HIV treatment at ART centres without the need for multiple visits. The linked system of ART centres and ICTCs with testing facilities ensures that patients receive comprehensive care efficiently.

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Dr Sandeep Sangale, Joint Director for TB and Leprosy in Maharashtra, highlighted the urgency of implementing the 1HP regimen. He pointed out that TB is a leading cause of morbidity and mortality among PLHIV. “People don’t die due to HIV alone; however, many succumb to TB infection, often due to delayed or inadequate treatment,” he remarked. This stark reality underscores the necessity of timely intervention and preventive strategies.

Advancements in TB Identification and Treatment

Advancements in medical technology and treatment protocols have enhanced the ability to identify and treat TB patients early. Dr. Sangale noted that early testing and treatment can significantly reduce morbidity and mortality associated with TB in PLHIV. Importantly, all services related to TB and HIV treatment in Maharashtra are offered free of charge, encouraging patients to seek the care they need without financial burden.

Bottomline

In conclusion, the introduction of the 1HP regimen in Maharashtra marks a critical step in the fight against tuberculosis among people living with HIV. By shortening the treatment duration and integrating services, the government aims to improve adherence and outcomes, ultimately saving lives. This initiative serves as a model for other regions grappling with the dual challenges of HIV and TB, emphasizing the importance of accessible, effective healthcare solutions for the most vulnerable populations.