Progress and challenges in tuberculosis preventive treatment in the Western Pacific Region: a situational analysis of seven high tuberculosis burden countries.

Background: Tuberculosis preventive treatment (TPT) can avert progression from infection to disease, yet scale-up across the World Health Organization Western Pacific Region is patchy. To guide acceleration, we assessed progress, challenges and responses in seven high-burden countries-Cambodia, China, Lao People's Democratic Republic (PDR), Mongolia, Papua New Guinea, the Philippines and Viet Nam-drawing on 2015-2023 programme data, structured questionnaires, follow-up interviews and a regional validation workshop.

Main body: Six of the seven countries have issued national TPT guidelines and five now offer shorter rifapentine- or rifampicin-based regimens. The number of people started on TPT rose sharply in most settings, driven by household contacts aged ≥ 5 years in Cambodia, Mongolia and the Philippines and by people living with HIV in Lao PDR and Papua New Guinea. However, coverage of children under five and other high-risk groups remains low. Cascade analysis revealed major attrition between screening and TPT initiation. Key obstacles, viewed through a socio-ecological lens, include: individual complacency, fear of adverse events and limited provider confidence; stigma and consent barriers in migrant households; intermittent staff training, medicine stock-outs and weak digital tools; long journeys to health facilities; and policy-practice gaps such as the absence of child-friendly formulations and non-notification of tuberculosis infection. Countries and partners endorsed a tiered package combining patient-centred counselling, mobile reminders, shorter paediatric regimens, stigma-reduction campaigns and remote e-consent. Health systems will reinforce staff training, digital supply-chain and adherence tools, while decentralised one-stop outreach and community health-workers extend coverage. A multisector task force will fast-track paediatric fixed-dose registration, make infection notifiable and absorb preventive treatment costs into national budgets and insurance schemes.

Conclusions: The introduction of shorter regimens and rising enrolment confirm that rapid gains are achievable, yet wide disparities persist across age groups, risk categories and care-cascade stages. Implementing the agreed client, community, institutional and policy interventions-backed by integrated governance and sustainable domestic funding-can convert TPT from a promising guideline into a routine, life-saving component of primary health care throughout the Western Pacific Region.