3. Tuberculosis prevention and screening

Preventing tuberculosis (TB) infection and stopping progression from infection to disease are critical for reducing TB incidence to the levels targeted by the End TB Strategy (1, 2).

The main health care intervention to stop progression from infection to disease is TB preventive treatment (TPT), which the World Health Organization (WHO) recommends for people living with HIV, household contacts of people with TB and other risk groups (3, 4). Strategies to provide TPT are often linked to screening to find and treat people with TB earlier in the course of their disease and thus help to reduce transmission and improve outcomes (4). Other TB preventive approaches are TB infection prevention and control (5), food assistance for household contacts in food-insecure settings (6, 7) and vaccination of children with the bacille Calmette-Guérin (BCG) vaccine.

Addressing broader determinants that influence TB epidemics is also fundamental to prevention of TB infection and disease; this topic is covered in Section 5.3.

3.1 TB preventive treatment

The global number of people living with HIV and household contacts of people diagnosed with TB who were provided with TPT increased from 1.0 million in 2015 to 3.6 million in 2019. There was then a sizeable reduction to 2.9 million in 2020 and 2021, probably reflecting disruptions to health services caused by the coronavirus (COVID-19) pandemic (Fig. 3.1). There was a substantial recovery to 3.9 million in 2022, above the pre-pandemic level. The total has increased in subsequent years, and was 5.2 million in 2025.

Since 2021, there has been a particularly noticeable increase in the number of household contacts enrolled on TPT: from 0.76 million in 2021 to 3.7 million in 2025. In contrast, the annual number of people living with HIV enrolled on TPT peaked at 3.0 million in 2019 and subsequently declined, to 1.5 million in 2025.

Fig. 3.1 Global number of people provided with TB preventive treatment (TPT), 2015–2025

At the second United Nations (UN) high-level meeting on TB in 2023, a new global target for TPT coverage was set (8). The target is to reach 90% coverage among people at high risk of developing TB disease by 2027.

TPT coverage has improved globally since 2015, but remained well below the target in 2025, for both household contacts (26%) and people living with HIV (60%) (Fig. 3.2). TPT coverage among household contacts has improved in all WHO regions since 2015.

Fig. 3.2 Trends in the coverage of TB preventive treatment (TPT), globally and by WHO region, 2015–2025

Ensuring access to shorter rifamycin-containing regimens may help to increase uptake of TPT. The annual number of people started on shorter rifamycin-containing regimens has increased substantially in recent years, both globally and in all WHO regions, especially since 2022 (Fig. 3.3). In 2025, 3.1 million people started shorter rifamycin-containing regimens worldwide, representing about 59% of all people who started TPT that year.

Fig. 3.3 Number of people started on TB preventive treatment (TPT) using a rifamycin-containing regimen, globally and by WHO region, 2018–2025

In 2025, 122 countries reported using the shorter rifamycin-containing regimens. Of these, 95 reported using the 3-month weekly regimen of rifapentine and isoniazid (3HP) and 30 reported using the 1-month daily regimen of rifapentine and isoniazid (1HP); 24 countries reported use of both regimens.

Since 2021, the annual number of people started on TPT using shorter rifamycin-containing regimens (3HP, 1HP, 3HR or 4R) has increased in most high TB burden countries (Fig. 3.4).

Fig. 3.4 Total number of people started on a shorter rifamycin-containing TB preventive treatment (TPT) regimen (3HP, 1HP, 3HR and 4R), 30 high TB burden countries, 2021–2025

In 2025, there were 48 countries in which 3HP or 1HP were provided to 75% or more of the people reported to have been initiated on rifamycin-based TPT (Fig. 3.5).

Fig. 3.5 Percentage of people started on a rifamycin-containing TB preventive treatment (TPT) regimen who were on a rifapentine-containing regimen (1HP or 3HP), by country, 2025

Rifampicin-based regimens were also being used in 2025: 90 countries reported using the 3-month daily regimen of rifampicin and isoniazid (3HR) and 47 reported using the 4-month daily regimen of rifampicin only (4R) (Fig. 3.6).

Fig. 3.6 Countries using TB preventive treatment (TPT) regimens containing rifampicin (3HR and/or 4R), 2025

The regimen of 6 months of levofloxacin (6Lfx) for contacts of people with multidrug-resistant TB (MDR-TB), approved by WHO in 2024 (3), was used in 52 countries in 2025, including 13 high TB burden countries (the Central African Republic, Ethiopia, India, Indonesia, Mongolia, Mozambique, Namibia, Papua New Guinea, the Philippines, South Africa, South Sudan, Thailand and Zambia) and 6 high RR-TB burden countries (Kazakhstan, Kyrgyzstan, Peru, the Russian Federation, Ukraine and Uzbekistan) (Fig. 3.7).

Fig. 3.7 Countries using TB preventive treatment (TPT) regimens containing levofloxacin (6Lfx) for contacts of people with MDR-TB, 2025

3.2 Household contacts

Globally in 2025, there were an estimated 14 million (95% uncertainty interval [UI]: 14–15 million) household contacts of people diagnosed with bacteriologically confirmed pulmonary TB. However, only 9.9 million contacts were reported in 2025; this was a 6.0% reduction from 11 million in 2024. Of these 9.9 million contacts, 8.5 million (85%) were evaluated for both TB infection and disease; this was a reduction of 8.7% from 9.3 million in 2024.

The percentage of contacts who were evaluated varied widely among countries (Fig. 3.8).

Fig. 3.8 Percentage of the reported number of household contacts of people newly diagnosed with bacteriologically confirmed pulmonary TB disease who were evaluated for TB disease and TB infection, by country, 2025

A total of 3.1 million household contacts aged 5 years and over started TPT in 2025; this was an 11% increase compared with 2024 (Fig. 3.1). The Democratic People’s Republic of Korea, Ethiopia, India, Indonesia and Nigeria accounted for over half of this increase.

In 2025, 0.54 million household contacts aged under 5 years started TPT out of an estimated 1.6 million who were eligible – a decrease from 0.65 million in 2024.

Globally, the 3.7 million household contacts provided with TPT in 2025 represented about 37% of the 9.9 million household contacts reported and 26% of the estimated total of 14 million household contacts. There was considerable variation among countries in the percentage of household contacts who were provided with TPT (Fig. 3.9).

Fig. 3.9 Percentage of the estimated number of household contacts of people newly diagnosed with bacteriologically confirmed pulmonary TB disease who were provided with TB preventive treatment (TPT), by country, 2025

Among the 90 countries that reported data, 75% of household contacts who started TPT in 2024 completed treatment, a reduction from 82% in 2023. The median in 2024 was 84% (interquartile range [IQR], 70–95%), a decline from 89% in 2023 (Fig. 3.10).

Fig. 3.10 Completion of TB preventive treatment (TPT) among household contacts, by WHO region and country, 2024

Globally, the cascade of TB preventive care shows a big gap between the number of household contacts screened for TB disease and the number starting TPT (Fig. 3.11).

Fig. 3.11 Cascade of care for provision of TB preventive treatment (TPT) to household contacts of people newly diagnosed with bacteriologically confirmed pulmonary TB disease, 2024

3.3 People living with HIV

Globally, the annual number of people living with HIV who received TPT increased from fewer than 30 000 in 2005 to 3.0 million in 2019 (Fig. 3.12). Subsequently, reported numbers have declined; the total was 1.5 million in 2025. A major explanation for this reduction is that large numbers of people living with HIV have already been provided with TPT, such that provision in several high TB/HIV burden countries is now mostly among people newly enrolled in HIV care.

Four high TB/HIV burden countries, accounting for 37% of the estimated global number of people living with HIV who developed TB in 2025, collectively accounted for 0.83 million (56%) of the global number of people living with HIV who were provided with TPT in 2025: India, Mozambique, South Africa and Zambia. Each of these countries provided TPT to more than 100 000 people living with HIV in both 2024 and 2025.

Among WHO regions, the annual number of people living with HIV provided with TPT has decreased in the African and European regions since 2019, and in the South-East Asia Region since 2018. In contrast, numbers have increased in the WHO Region of the Americas since 2020; this includes a sharp rise between 2024 and 2025, driven largely by an increase in Brazil. There has also been a marked increase in the Eastern Mediterranean Region since 2023, mainly explained by increases in Egypt and Pakistan.

Between 2005 (the year following the publication of the first WHO policy guidance on collaborative TB/HIV activities) (9) and the end of 2025, 22 million people living with HIV were initiated on TPT (10).

Among the 81 countries that reported data, 60% of people living with HIV who were newly started on ART received TPT in 2025. The median was 38% (IQR: 9.1–69%).

Fig. 3.12 Provision of TB preventive treatment (TPT) to people living with HIV, globally and by WHO region, 2005–2025

Among the 49 countries that reported data, 87% of people living with HIV who started TPT in 2024 completed their treatment, a decline from 90% in 2023 (Fig. 3.13). The median in 2024 was 91% (IQR: 72–97%), an increase from 84% in 2023.

Fig. 3.13 Completion of TB preventive treatment (TPT) initiated in 2024 among people living with HIV, by WHO region and country

3.4 Screening for TB disease in household contacts and other high-risk groups

Among 119 countries that reported the results of TB screening in household contacts in 2025, the overall yield of people with TB was 1.5% (median: 2.0%; IQR: 0.70–4.6%) (Fig. 3.14). This is slightly lower than what would be expected in household contacts of people with bacteriologically confirmed TB (11). The wide variation among countries probably reflects differences in the coverage of screening for eligible individuals, the diagnostic algorithms being used and the completeness of reporting.

Fig. 3.14 Percentage of household contacts diagnosed with TB disease among those screened, by WHO region, 2025

In 2025, 113 countries reported the number of people newly diagnosed with TB who were identified through provider-initiated screening efforts in high-risk groups such as contacts, people living with HIV, people in prisons and mining communities, and through facility-based screening of people with diabetes and other case finding activities (Fig. 3.15). In these countries, the overall proportion of people newly diagnosed with TB detected through screening was 23% (median: 11%; IQR: 3.6–26%). The 113 countries included 24 high TB burden countries; among this subset, the proportion was 22% (median: 12%; IQR: 2.7–39%).

In 2024, 56 out of 66 priority countries reported data about the availability of chest radiography for regular TB screening or active TB case-finding campaigns. Of those 56 countries, 34 (61%) reported the regular use of chest radiography – with or without computer-aided detection software – in 75% or more of administrative units in the country (median coverage for 56 countries: 97% of administrative units, IQR: 26–100%).

Fig. 3.15 Percentage of people newly diagnosed with TB (new and recurrent cases) reported through TB screening efforts, 2025

3.5 Tests for TB infection

Tests for TB infection can help to target TPT to people who can gain the most benefit from it. In 2025, 96 countries reported using tuberculin skin tests (TST), interferon gamma release assays (IGRA) or antigen-based skin tests in either the public or private sectors to deliver TPT to populations at risk (Fig. 3.16). Of the 34 countries reporting no use of tests for TB infection, 26 were in the WHO African Region.

Fig. 3.16 Diagnostic tests used for TB infection, by country, 2025

3.6 TB infection prevention and control

The risk of TB among health care workers relative to the risk in the general adult population is one of the indicators that WHO recommends for measuring the impact of TB infection prevention and control interventions in health care facilities. If effective prevention measures are in place, the risk ratio for TB in health care workers compared with the general adult population should be close to 1.

In 2025, 22 334 health care workers from 65 countries were reported to have been diagnosed with TB. The ratio of the TB notification rate among health care workers to the general adult population was greater than 1 in 18 countries that reported 5 or more health care workers diagnosed with TB (Fig. 3.17).

Fig. 3.17 Notification rate ratio of TB among health care workers compared with the adult population, by country, 2025

3.7 Bacille Calmette-Guérin vaccination

Bacille Calmette-Guérin (BCG) vaccination is recommended as part of national childhood immunization programmes, in line with a country’s TB epidemiology (12). Global coverage dropped from 89% in 2019 to 86% in 2020 and 84% in 2021, probably due to disruptions to health services caused by the COVID-19 pandemic, but has subsequently recovered (Fig. 3.18) (13). Coverage was 88% in 2025.

Fig. 3.18 BCG vaccination coverage in infants,^a globally and by WHO region 2015–2025

References

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8. Resolution 78/5: Political declaration of the high-level meeting of the General Assembly on the fight against tuberculosis. New York: United Nations; 2023 (https://undocs.org/A/RES/78/5).

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10. UNAIDS epidemiological estimates, 2026 (https://aidsinfo.unaids.org/).

11. Velen K, Shingde RV, Ho J, Fox GJ. The effectiveness of contact investigation among contacts of tuberculosis patients: a systematic review and meta-analysis. Eur Respir J. 2021 Dec 9;58(6):2100266. (https://doi.org/10.1183/13993003.00266-2021).

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13. The WHO Global Health Observatory (https://www.who.int/data/gho/data/indicators/indicator-details/GHO/bcg-immunization-coverage-among-1-year-olds-(-)). Data downloaded 27 July 2026.

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