TB YOUTH - TB SYstemic Management Using One-month, Ultra-short TPT Regimen for ScHool Contacts

This is a prospective, multi-center, open-label, cluster randomized controlled clinical trial conducted in school settings to estimate the non-inferiority effect of 1H3P3 compared with 3HR.

Background： Adolescents are susceptible to tuberculosis. Almost 1.1 million children (aged below 15 years) and another half a million older adolescents (15-19 years) become ill with TB every year. Approximately 5%-10% people infected with TB develop to active disease, which suggest that a great proportion of adolescents remain undiagnosed and unprotected. Undiagnosed cases and school-based transmission contribute to the burden of TB among adolescents. Closing the gap in targeted interventions for TB prevention in schools is essential to break the cycle of transmission and ensure the well-being of school-aged adolescents. However, TB preventive treatment targeted on adolescents are still lacking.

Method： This is a prospective, multicenter, open-label, non-inferiority, cluster randomized controlled clinical trial within the national tuberculosis control program of GuiZhou,China. Close contacts of school tuberculosis index cases are actively screened with QFT(QuantiFERON-TB Gold Plus), chest X-ray, pooled GeneXpert MTB/RIF test of sputum and symptoms. After ruling out active tuberculosis, LTBI students are enrolled to attend a non-inferiority, cluster randomized controlled clinical trial. The students will be given either 3HR or 1H3P3 regimen and followed for two years. Our primary endpoint is culture or GeneXpert MTB/RIF confirmed TB or clinically highly suggested TB. Assume ICC (interclass correlation coefficient) to be 0.05, and the the lost to follow-up rate is 10%, the study will need 1760 subjects per arm to provide 80% power to detect a 20% non-inferiority margin of primary endpoint between the two arms.

Discussion:

The effectiveness of contact investigation among adolescent students as a tool for improved tuberculosis control has not been established. The integration of ultra-short treatment regimens with active screening holds the potential to provide a comprehensive and effective strategy for tuberculosis prevention and control in school environments, which may help reform the national tuberculosis policy regarding adolescent TB.

Eligibility Criteria:
Inclusion Criteria:

1. Male or female, ≥13 years old, weighting ≥30kg;
2. Students of junior middle school, high school or college, or school staff;
3. In the scope of ATB case-driven screening delimited by local CDC;
4. Positive in IGRA test and diagnosed as LTBI;
5. Voluntary (together with his/her guardian for age under 18 years old) participant in trial and signed informed consent.

Exclusion Criteria:

1. Current clinical or sputum culture confirmed active tuberculosis
2. Had continuously taken rifamycin (rifampicin, rifapentine etc.) or isoniazid for more than 14 days in the past 2 years
3. Have completed a full course of treatment for ATB or LTBI
4. Allergic or intolerant to rifamycin (rifapentine or rifampicin) or isoniazid
5. HIV (human immunodeficiency virus) antibody positive or AIDS (Acquired immunodeficiency syndrome) patients
6. History of viral hepatitis (e.g. chronic hepatitis B, chronic hepatitis C) or liver cirrhosis
7. Liver dysfunction (Total bilirubin \> 5mg/dL (43 umol/L) or Alanine aminotransferase \> 2ULN or Aspartate aminotransferase \> 2ULN) or renal dysfunction
8. Current receiving immunosuppressive therapy or biological agents
9. Blood system diseases or Platelet count\<50×10\^9/L or White Blood Cell count\<3.0×10\^9/L
10. Other conditions deemed unsuitable for TPT by physician.