TB preventive therapy (TPT) is one of the three key interventions for reducing TB disease in South Africa. Currently isoniazid (IPT) is the TPT regimen of choice.

Global shortage of the tuberculin skin test (TST) has made the implementation of the IPT guidelines difficult. Recently the National Department of health sent out a circular regarding this. They requested all public health facilities to:

• Scale up targeted TB screening and ensure linkage to TPT for all eligible PLHIV
• Initiate TPT at ART initiation for all eligible patients
• Scale up targeted TB screening and ensure linkage to TPT for all eligible children less than five years of age who are household or close contacts of individuals with pulmonary TB
• Initiate TPT in patients who screen negative for active TB disease (i.e. active TB has been excluded) and are eligible for TPT. TST is no longer required prior to TPT initiation.
• Standardise the duration of TPT:

1. Adult ART (15+ years of age) should receive and complete TPT for a duration of 12 months as per the national guidelines
2. Children who are contacts of index TB cases (< 5 years of age) regardless of HIV status, and PLHIV > 5 and < 15 years of age should receive and complete TPT for a duration of six months as per the national guidelines

• Ensure monitoring of adverse events and adhere to recording and reporting requirements