Tuberculosis Preventive Therapy (TPT)

Please click on the link below to access the most up-to-date version of this guideline. The content on this page is currently being updated to align with the latest publication. Always check the version number at the bottom of the screen to confirm which version you are using.

Click here to access the Primary Health Care - PHC Chapter 11: Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV and AIDS) - 26 February 2026

---

Eligibility

Exclusions

---

Z29.2 + (B24)

PLHIV, at any CD4 count, are more susceptible to TB infection than HIV-uninfected people. TPT is an effective intervention for reducing the incidence of TB in PLHIV.

ELIGIBILITY

All adult PLHIV, irrespective of CD4 count and ART status.

EXCLUSIONS

• Suspected or confirmed TB
• Painful peripheral neuropathy
• Liver disease
• Alcohol use disorder
• Previous MDR- or XDR-TB

---

Note:
- Exclude TB before initiating TPT by screening for the following:
- cough (any duration)
- weight loss
- cever
- night sweats
- Do not start TPT if any of the above symptoms are present. These patients require further investigation for active TB. 

---

LoE:IIb³¹

• Start TPT together with ARVs: 
  • TPT, e.g.:
    • Isoniazid, oral, 300 mg daily for 12 months.

Adults and adolescents initiating a DTG-containing ART regimen:

• Isoniazid daily for 12 months is the preferred regimen.

For patients who are already virally suppressed on a DTG-based regimen:

• A weekly combination of isoniazid (900mg if weight >30 kg) plus rifapentine (900mg if weight >30 kg) for three months may be used.
  • Do not use rifapentine-containing TPT in patients on protease inhibitor-based ART, or in women on hormonal contraceptives. [See the therapeutic interchange database for details regarding the rifapentine-containing TPT regimen].
  • Educate patients on the symptoms of hepatotoxicity (nausea, vomiting, yellow eyes, brown urine, and pain in right upper quadrant) associated with TPT.

LoE:IIb³²

ADD

• Pyridoxine, oral, 25 mg once daily for the full duration of the TPT regimen.
  • Instruct patient to present early if any of these symptoms arise.
  • Follow patients up monthly for the first 3 months.

---

NOTE:

For pregnant women:
- Defer TPT until after delivery
- Ensure that routine screening against TB is conducted at each antenatal visit.

---

LoE:IIb³³

Click here to access the pdf.

---

Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 2.1_09 December 2024

Chapter 11: Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV AND AIDS)_11.2 Opportunistic Infections, Prophylaxis in Adults_11.2.2 Tuberculosis Preventive Therapy (TPT)