Shorter treatments for latent tuberculosis in the Northern Territory: a pragmatic effectiveness study

Australia has achieved considerable progress in the control of TB. Despite this, the Northern Territory has the highest rate of TB in Australia, and there remains a significant gap in the burden of TB disease among Aboriginal and Torres Strait Islander Australians compared to Australian born non-Indigenous persons.

Treatment of latent TB infection (LTBI) is a key strategy to prevent TB disease, however the first-line recommendation for latent TB treatment in the Northern Territory is 9 months of daily isoniazid tablets. In part due to the long duration, less than half of those who are offered latent TB treatment achieve treatment completion.

A new, shorter regimen for the treatment of LTBI has been shown to be safe and effective. The duration is just three months and involves a once-weekly dose of two drugs, isoniazid and rifapentine. This new regimen shows great promise for improving uptake and completion of treatment for latent TB infection, however it has not been widely taken up in Australia because rifapentine is not commercially available.

In this study, we will implement the new 3-month regimen for LTBI treatment in the Northern Territory and will evaluate its feasibility and acceptance. We will measure and compare treatment completion and adverse events with the former 9-month regimen and determine the cost-effectiveness of the new model of care compared with current standard practice.