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Scaling up preventive therapy should be an urgent priority in regions that need it most Tuberculosis (TB) is the leading cause of infectious disease deaths globally, killing three people every minute.1 The World Health Organization (WHO) published its End TB Strategy 12 in 2015, which set ambitious and laudable targets to reduce global incidence by 90% and deaths from TB by 95% by 2035. When global actors and heads of state convene in New York for the second UN high level meeting on TB on 22 September 2023, however, the scorecard will reflect dismal progress.34 Among the failures, only 12.5 million adults of the 30 million targeted by the political declaration have received TB preventive therapy,1 despite the original 2021 goal. TB preventive therapy, long neglected as an effective component of strategies to eliminate tuberculosis,1 is a course of medication to treat people who are infected with Mycobacterium tuberculosis but do not have active TB disease: their immune system is cont

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