In their normative and planning documents, national TB and HIV authorities and other stakeholdersshould clearly define priority populations for PMTPT. The aim should be to provide lasting protectionfrom progression to TB disease to a maximum number of individuals at risk, thus limiting continuedtransmission and reinfection and reducing TB incidence over time. People with HIV and householdcontacts were the primary targets for global action by Member States at the United Nations high-level meetings in 2018 and 2023 (6,43). The GDG stressed that the best available evidence should beused to ensure that the benefits outweigh the risks to individuals in these groups and to make the bestpossible use of resources, which could yield savings for the entire health-care system. Any additionalresources necessary to implement the guidance should not be viewed as a barrier but should stimulateprogrammatic mobilization of more funding. The GDG noted the value of ART in preventing TB inpeople with HIV and urged countries to ensure universal access to ART, as per WHO policy (44).Provision of TPT for people with HIV should be a core component of the HIV package of care andshould be the responsibility primarily of national HIV/AIDS programmes and HIV service providers(44,45). Some household contacts and other people eligible for TPT (e.g. people receiving dialysis,prisoners) will also be HIV positive and would therefore require individual attention to minimize thelikelihood of developing TB disease. Care should be coordinated with the health services responsiblefor TB. TPT should be viewed as one of a comprehensive set of interventions. Among people withHIV who were treated for TB in the past, TPT should be prioritized for adults and adolescents whohave been re-exposed to TB.In addition to HIV care, nutrition supplementation has been shown to reduce the risk of TB diseaseby 39–48% in household contacts who are undernourished (46).Confirmation of TBI with either IGRA or skin testing and reliable exclusion of TB disease with sensitivetests such as CXR are desirable before starting TPT. If these tests are not available, TPT should not bewithheld from eligible people if TB disease has been excluded on clinical grounds alone (see section 1.2).Identification of populations for TBI testing and TPT raises various ethical issues (47,48). First, as TBIis an asymptomatic, non-contagious state, the ethical obligations are different from those for TBdisease. For example, in the absence of an immediate risk of transmission, it would be unethical torestrict the movement of a person with TBI who refuses treatment. Lack of evidence of the benefitof systematic testing and treatment in certain populations (e.g. people with diabetes or who are1. Recommendations 9underweight) should not preclude offering preventive treatment to individuals with these conditionswho are judged to be at increased risk of progression. Secondly, lack of tests for measuring individualrisk for development of TB disease may complicate communication. Informed consent requireseffective, adequate communication to each person about the uncertainty of current TBI tests topredict progression to TB disease, individual host variation and the protective benefit expected fromtreatment versus adverse reactions. Appropriate means to obtain informed consent should complywith international human rights standards and account for differences in language, literacy andlegal status. Risk and uncertainty must be communicated in a way that is culturally and linguisticallyappropriate, including to people whose first language is not that of the local setting, to children and topeople in prison. User feedback collected during screening programmes is useful for communication.Thirdly, TBI disproportionately affects individuals and groups that are already disadvantaged due tofactors such as disease, socio-economic situation or legal status. Efforts must be made to address anyinequity in access to services and to uphold human rights, so that the vulnerability of target groupsdoes not impede their access to screening and treatment or violate their rights. Any intervention forvulnerable groups, including people in prisons and children, should include measures to minimizethe risk of stigmatization, such as protecting confidentiality of personal data and informed consent.The GDG emphasized that a person’s status – positive for TBI or receiving TPT – should not affectany immigration procedure or entry to the host country, and this should be reflected in laws or otherregulations. People should be tested for TBI and receive TPT in strict adherence to human rights andethical considerations (49). Policies should be evaluated by users from an ethical perspective andthe views and experiences of affected populations collected after implementation, both to considerpossible unexpected effects and to ensure that the evidence on which they are based remains currentand relevant (50). Person-centred TBI care includes equitable provision, with no added disadvantagefor marginalized and vulnerable populations, and emphasizes the human rights aspects of TPTso that appropriate safeguards are included in law, policy and practice to minimize any additionalstigmatization, discrimination, violation of bodily integrity or restrictions on freedom of movement.In person-centred TBI care, people who are offered testing and treatment must understand theuncertainties, so that they can participate in care options. These guiding principles are based onestablished principles of human rights such as consent, non-coercion and confidentiality (48).