3HP Regimen

NTCA Provider Guidance

Using the Isoniazid/Rifapentine Regimen to Treat Latent Tuberculosis Infection (LTBI)

Concise Guide to Best Practices across the United States

NTCA is pleased to announce release of its guidance for providers considering using the isoniazid-rifapentine (3HP) regimen to treat LTBI.

The Centers for Disease Control and Prevention (CDC) recently released guidance on the 3HP regimen in the article Update of Recommendations for Use of Once-Weekly Isoniazid-Rifapentine Regimen to Treat Latent Mycobacterium tuberculosis Infection, MMWR, June 29, 2018;67(25):723–726. This update has expanded the criteria for when to treat patients for LTBI using the 3HP regimen as well as for when to it is possible to administer the 3HP regmen through self-administered therapy.

The NTCA created Using the Isoniazid/Rifapentine Regimen to Treat Latent Tuberculosis Infection (LTBI) primarily for our private provider partners to supplement the CDC’s guidance. However, this NTCA provider guidance contains essential information for all providers treating LTBI including providers in the TB public health community.

Developed from current best practices and evidence-based knowledge in use by several of our member programs across the United States, Using the Isoniazid/Rifapentine Regimen to Treat Latent Tuberculosis Infection (LTBI) was designed to help clinical providers and nursing managers

  1. Quickly identify and answer key questions when considering whether to start a patient on the 3HP regimen
  2. Assess the appropriateness of self-administered therapy of 3HP for each individual patient
  3. Ensure that the correct drugs for the 3HP regimen are prescribed and provided to the patient
  4. Handle questions on side effects and adverse reactions for a patient currently on the 3HP regimen

This project demonstrates the power of our programs sharing their resources and knowledge and collaborating to determine the best practices for national distribution. Our thanks and acknowledgements go out to Ann Scarpita for her TB nurse consultant expertise and for her leadership and persistence in steering the process of developing this guidance. For sharing their resources for adaptation during this process, we thank our colleagues in California, Oregon, and New York City. For their commitment to providing the best practices from their experience and knowledge, we thank the workgroup members Heidi Behm, Marcos Burgos, Diana Fortune, Diana Nilsen, Ann Scarpita, Suzanne Wilson and reviewers John Bernardo and Jon Warkentin. Finally, for her skill in fitting the guidance readably onto two pages, we send a big thanks to Edi Berton.

Download Your Copy

Using the Isoniazid/Rifapentine Regimen to Treat Latent Tuberculosis Infection (LTBI) is available in PDF format by online download. To start your download, click here. Please note that we are collecting minimal contact information prior to download. The information will be used to conduct an evaluation to learn how this resource is being utilized and by whom.

References

  1. Sterling TR, Villarino M, Borisov A, et al.Three months of rifapentine and isoniazid for latent tuberculosis infection. The New England Journal of Medicine. 2011;365(23):2155–2166.
  2. Villarino M, Scott N, Weis S, et al. Treatment for Preventing Tuberculosis in Children and Adolescents. JAMA Pediatrics. 2015;169(3):247–255.
  3. Belknap R, Holland D, Feng PJ, et al. Self-administered Versus Directly Observed Once-Weekly Isoniazid and Rifapentine Treatment of Latent Tuberculosis Infection: A Randomized Trial. Annals of Internal Medicine. 2017;167(10):689-697.
  4. Centers for Disease Control and Prevention. Update of Recommendations for Use of Once-Weekly Isoniazid-Rifapentine Regimen to Treat Latent Mycobacterium tuberculosis Infection. MMWR. 2018;67(25):723–726.
  5. Holland D, Sanders G, Hamilton C, Stout J. Potential economic viability of two proposed rifapentine-based regimens for treatment of latent tuberculosis infection. Public Library of Science ONE. 2011;6(7). E22276.
  6. Martinson N, Barnes G, Moulton L, et al. New regimens to prevent tuberculosis in adults with HIV infection. New England Journal of Medicine. 2011;365:11–20.
  7. Schechter M, Zajdenverg R, Falco G, et al. Weekly rifapentine/isoniazid or daily rifampin/pyrazinamide for latent tuberculosis in household contacts. American Journal of Respiratory Critical Care Medicine/ 2006:173:922–926.
  8. Sterling TR, Moro RN, Borisov AS, et al. Flulike and other systemic drug reactions among persons receiving weekly refapentine plus isoniazid or daily isoniazid for treatment of latent tuberculosis infection in the PREVENT tuberculosis study. Clinical Infectious Diseases. 2015;61(4):527–535.
  9. Tuberculosis Control Branch. Fact Sheet: 12-dose Isoniazid (INH)/Rifapentine Regimen for Latent TB Infection Treatment. California Department of Public Health [website]. Richmond, CA: March 2017.
  10. Public Health Division. 12-dose Isoniazid (INH)/Rifapentine Regimen (3HP) for Treatment of Latent TB Infection (LTBI). Oregon Health Authority. Portland, OR: July 2018.