Diabetes mellitus (DM) increases susceptibility to Tuberculosis (TB) and worsens TB patient outcomes. The number of patients with combined TB and DM now outnumbers that of combined TB and HIV and it has been estimated that 15-30% of TB disease may be attributable to diabetes globally. This may be expected to rise substantially as DM prevalence increases. Treatment of Latent TB Infection (LTBI) in this population will likely have a significant clinical benefit. Similar to HIV-infected individuals, those with DM might benefit from therapy to prevent the development of TB disease. Current international guidelines do not recommend LTBI management in people with DM, but this is because no studies have examined the risk-benefit ratio of such an intervention. To date, no RCTs have been conducted to investigate the efficacy and safety of preventive treatment of LTBI in DM patients. Based on evidence on effectiveness, safety, and treatment completion rates, 3HP has been selected as the regimen of choice for this study of African people living with DM. People living with DM will be randomized to 3HP or placebo to determine the efficacy of 3HP in the prevention of TB disease in this population. PROTID's preventive treatment of LTBI among people with DM will generate the first solid evidence to support or refute the use of preventive treatment against TB in people with DM.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
QUADRUPLE
Enrollment
3,000
Oral combination of rifapentine (RPT, 900 mg) and isoniazid (INH, 900 mg), once-weekly for 12 weeks.
Participants in the control group will receive placebo once weekly for 12 weeks
Mbeya zonal referral hospital
Mbeya, Tanzania
RECRUITINGKilimanjaro Christian Medical Center
Moshi, Tanzania
RECRUITINGMakerere University
Kampala, Uganda
RECRUITINGMartyrs Hospital Lubaga
Kampala, Uganda
RECRUITINGFirst diagnosis of TB
The primary outcome will compare the rate of occurrence of TB disease (defined as definite or probable TB) in treatment and control groups. Definite TB disease will be confirmed by a culture or Xpert positive result for M. tuberculosis. Probable TB will be diagnosed according to an algorithm that takes into account symptoms, chest x-ray reading, sputum smear, histology and verbal autopsy results.
Time frame: Through study completion, median of 33 months follow-up
Occurrence of possible, probable or definite TB disease
Time frame: At least 24 months post randomisation
Occurrence of an adverse event
Time frame: From randomisation to 60 days after end of study treatment
Treatment completion
Time frame: Defined as > 11 of 12 doses of treatment over no more than 16 weeks.
All-cause mortality
Time frame: At least 24 months post randomisation
Occurrence of possible, probable, or definite TB, or death
Occurrence of possible, probable, or definite TB, or death, noting that a proportion of deaths are likely to be due to TB but not possible to confirm through verbal autopsy and clinical notes review.
Time frame: At least 24 months post randomisation
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.