Zambia's TB Prevention Push Reached 14,000 Contacts

Zambia's TB preventive therapy, called TPT, has become easier to access for people living with HIV. The bigger gap has been people without HIV who live with someone who has bacteriologically confirmed TB. This matters because preventive therapy can reduce TB illness by as much as 60% in HIV-negative people. Still, there has been little program data from Zambia or the wider region showing how to deliver it at scale for contacts aged five and older.

To test a bigger effort, Zambia's National TB Programme and the TB Local Organizations Network ran a surge from October 2024 to January 15, 2025. It covered 89 facilities carrying a high TB burden across eight provinces receiving project support. After a careful planning stage, teams with different roles went into the field to find contacts and start therapy for eligible household members. Facilities also let walk-in clients begin treatment there. The team used summary records from facility registers for analysis.

The numbers show both progress and a supply problem. Out of 19,371 HIV-negative contacts aged five or older who were screened, 19,344 were eligible and offered therapy. That was 99.9% of those screened. In the end, 14,000 people, or 72.4%, started TPT. Some 385 people, or 2.0%, said no. Another 4,959 people, or 26.2%, did not start because the regimen they preferred was not available. When the surge began, TPT coverage jumped by 47.7 percentage points, with a p-value of 0.001.

Most starts used a three-month Isoniazid and Rifapentine plan: 8,917 people, or 63.7%. A six-month Isoniazid plan came next, with 4,226 people, or 30.2%. Smaller groups used a one-month Isoniazid and Rifapentine plan, with 625 people, or 4.5%, or a three-month Isoniazid and Rifampicin plan, with 232 people, or 1.7%. The activity showed that high initiation was possible through focused planning, stakeholder work, and community-led steps. It also points toward extending preventive therapy to TB contacts without using HIV status or age as a barrier. It raises a simple program question: if a preferred option is missing, are people truly being offered the care they need?