Annexure C: TPT Integration into Repeat Prescription Collection Strategies for Clinically Stable PLHIV on ART
Background Completion of TPT prior to enrolment in differentiated service delivery (DSD) model TPT initiation and completion within DSD model Transition to TLD regimen Background South African Adherence Guidelines enable clinically stable ART patients to access multi-month ART supply and easier drug supply collection through Repeat Prescription Collection Strategies (RPCs), namely facility pick-u
Completion of TPT prior to enrolment in differentiated service delivery (DSD) model
TPT initiation and completion within DSD model
Background
South African Adherence Guidelines enable clinically stable ART patients to access multi-month ART supply and easier drug supply collection through Repeat Prescription Collection Strategies (RPCs), namely facility pick-up points, adherence clubs and external pick-up points, from six months on ART and other chronic conditions. These RPCs are either based at their health facility or in the community, including at private pharmacies, private general practitioners and community venues.
Patients should not be prevented from accessing RPCs, which support long-term adherence and retention, when completing their course of TPT. In addition, patients already enrolled in RPCs who previously missed TPT should be provided with access to TPT without being removed from their RPCs.
Completion of TPT prior to enrolment in differentiated service delivery (DSD) model
Where patients have started TPT at ART start and the TPT treatment course is shorter than six months (e.g., 3HP), TPT should be completed prior to the assessment for and enrolment in RPCs (facility pick-up points, adherence clubs or external pick-up points).
Where patients have started TPT at ART start or after ART start but not completed their TPT course prior to enrolment in an RPCs, at least three months of TPT must have been completed and clinical assessment for adverse events undertaken. Where a patient is assessed as clinically stable on TPT, TPT treatment supply can be provided on the same multi-month basis as ART supply and can be provided through the same RPCs.
TPT initiation and completion within DSD model
Where adult patients are already enrolled in a RPCs (facility pick-up point, adherence club or external pick-up point) and have previously missed TPT, these patients should be supported to complete a course of 12H within their RPCs model. These patients should be assessed at their annual comprehensive clinical consultation visit by their clinician for TPT eligibility and if eligible, initiated on TPT and scripted for six months of ART and TPT treatment supply. Patients will collect their TPT supply within their RPCs model but will be required to return to the health facility one month after TPT start for clinical follow-up. Thereafter, RPCs patients will be screened for any TB symptoms or side effects by their RPCs service provider and referred to their health facility should any side effects or ill health be identified for followup. Emphasis must be placed on patient treatment literacy, especially at TPT start, to support patients to identify any side effects and return to their health facility outside of scheduled appointment dates if necessary. Patients will have a further TPT clinical follow-up assessment at six months when returning for their RPCs rescripting visit and for their TPT completion assessment at their next annual comprehensive clinical consultation visit.
Transition to TLD regimen
For patients making use of RPCs who are eligible and opting to switch to TLD, TPT eligibility should be assessed at switch. For TPT eligible patients, 3HP could be offered to the patient to be started with TLD, provided the patient agrees to additional facility clinical review dates. Alternatively, 12H can be scripted and aligned with RPCs review dates.
National Guidelines on The Treatment of Tuberculosis Infection, February 2023
Annexure C: TPT Integration into Repeat Prescription Collection Strategies for Clinically Stable PLHIV on ART